Healthcare Provider Details

I. General information

NPI: 1154085223
Provider Name (Legal Business Name): NATASHA HART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATASHA REISTER LMSW

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 01/06/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 UNIVERSITY AVE STE B
GRAND FORKS ND
58203-1938
US

IV. Provider business mailing address

2701 12TH AVE S
FARGO ND
58103-8753
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-4584
  • Fax: 651-925-0057
Mailing address:
  • Phone: 701-451-4900
  • Fax: 651-925-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5871
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5871
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: