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General NPI Number Information
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NPI Number | 1255633244
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Entity Type | Individual
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Provider Name | JONA RAE PELTIER LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 1015 HOSPITAL RD SUITE A
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City | BELCOURT
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State | ND
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Zip | 58316-0160
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Country | US
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Telephone | 701-477-0455
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Fax | 701-477-0457
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Provider Business Mailing Address
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Address Line | 1015 HOSPITAL RD. SUITE A PO BOX 1149
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City | BELCOURT
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State | ND
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Zip | 58316-0160
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Country | US
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Telephone | 701-477-0455
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Fax | 701-477-0457
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4507
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License Number State | ND
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