Healthcare Provider Details

I. General information

NPI: 1043174030
Provider Name (Legal Business Name): JODI MONK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 14 1/2 AVE E
WEST FARGO ND
58078-3451
US

IV. Provider business mailing address

1455 32ND ST S UNIT 9191
FARGO ND
58103-3400
US

V. Phone/Fax

Practice location:
  • Phone: 701-866-9992
  • Fax:
Mailing address:
  • Phone: 701-866-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: