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General NPI Number Information
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NPI Number | 1417490160
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Entity Type | Individual
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Provider Name | KATRINA KANWISCHER-JAGIM
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Gender | Female
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 835 CINNAMON RIDGE PL
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City | WEST FARGO
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State | ND
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Zip | 58078-8190
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Country | US
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Telephone | 218-303-5829
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Fax |
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Provider Business Mailing Address
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Address Line | 835 CINNAMON RIDGE PL
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City | WEST FARGO
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State | ND
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Zip | 58078-8190
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Country | US
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Telephone | 218-303-5829
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2016-036A
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2019-071
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License Number State | ND
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