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General NPI Number Information
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NPI Number | 1629566583
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Entity Type | Individual
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Provider Name | SADIE PAMELA KIESON LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 222 UNIVERSITY AVE
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City | WILLISTON
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State | ND
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Zip | 58801-5658
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Country | US
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Telephone | 701-421-7640
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Fax |
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Provider Business Mailing Address
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Address Line | 222 UNIVERSITY AVE
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City | WILLISTON
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State | ND
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Zip | 58801-5658
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Country | US
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Telephone | 701-444-3661
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Fax | 701-444-6436
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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 | 6331
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License Number State | ND
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