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General NPI Number Information
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NPI Number | 1245092279
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Entity Type | Individual
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Provider Name | MARY NAOMI JAHN LADC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 1234 E HIGHWAY 7
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City | MONTEVIDEO
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State | MN
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Zip | 56265-1705
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Country | US
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Telephone | 320-269-6581
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Fax | 855-562-7905
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Provider Business Mailing Address
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Address Line | 1234 E HIGHWAY 7
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City | MONTEVIDEO
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State | MN
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Zip | 56265-1705
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Country | US
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Telephone | 320-269-6581
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Fax | 855-562-7905
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 303665
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License Number State | MN
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