Healthcare Provider Details

I. General information

NPI: 1972481141
Provider Name (Legal Business Name): WEST FARGO PUBLIC SCHOOL DISTRICT 6 NON-IEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 2ND AVE NW
WEST FARGO ND
58078-1317
US

IV. Provider business mailing address

2028 2ND AVE NW
WEST FARGO ND
58078-1317
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PENNY HENDERSON
Title or Position: MEDICAID SPECIALIST
Credential:
Phone: 701-499-1028