Healthcare Provider Details

I. General information

NPI: 1629480868
Provider Name (Legal Business Name): JAMES T KWASNESKI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 J ST
GRAND FORKS AFB ND
58205-6306
US

IV. Provider business mailing address

1599 J ST
GRAND FORKS AFB ND
58205-6306
US

V. Phone/Fax

Practice location:
  • Phone: 701-747-5376
  • Fax: 630-570-6356
Mailing address:
  • Phone: 701-747-5376
  • Fax: 630-570-6356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW15980
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7168
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: