Healthcare Provider Details

I. General information

NPI: 1558458265
Provider Name (Legal Business Name): TAMMY DAWN NESS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS TAMMY DAWN SWALLERS

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 20TH AVE SW STE 4
MINOT ND
58701-6572
US

IV. Provider business mailing address

104 20TH AVE SW STE 4
MINOT ND
58701-6572
US

V. Phone/Fax

Practice location:
  • Phone: 701-720-8876
  • Fax:
Mailing address:
  • Phone: 701-720-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1712
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier028715
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier19192
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: