Healthcare Provider Details

I. General information

NPI: 1255417713
Provider Name (Legal Business Name): JOANN M SCHMITZ LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANN M ECCLESTON LSW

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 2ND AVE W
WILLISTON ND
58801-5218
US

IV. Provider business mailing address

PO BOX 1266
WILLISTON ND
58802-1266
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-4600
  • Fax: 701-774-4620
Mailing address:
  • Phone: 701-774-4600
  • Fax: 701-774-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number299
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: