Healthcare Provider Details

I. General information

NPI: 1003496589
Provider Name (Legal Business Name): MEGGAN MICHELLE SEVERSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 3RD ST NW
JAMESTOWN ND
58401-2968
US

IV. Provider business mailing address

1701 S 12TH ST
BISMARCK ND
58504-6644
US

V. Phone/Fax

Practice location:
  • Phone: 701-253-6300
  • Fax:
Mailing address:
  • Phone: 701-751-0384
  • Fax: 888-901-7234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6054
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0654
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: