MEDICARE: DARNELL M ECKERT LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	2772	ND

General Provider Information

NPI Number	:	1215159884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARNELL M ECKERT LSW

Provider Business Mailing Address
First Line	:	1237 W DIVIDE AVE
Second Line	:	SUITE 5
City	:	BISMARCK
State	:	ND
Zip	:	58501-1220
Country	:	US
Telephone Number	:	701-328-8884
Fax Number	:	701-328-8900

Provider Business Practice Location Address
First Line	:	1237 W DIVIDE AVE
Second Line	:	SUITE 5
City	:	BISMARCK
State	:	ND
Zip	:	58501-1220
Country	:	US
Telephone Number	:	701-328-8884
Fax Number	:	701-328-8900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/17/2014

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Directions to “ DARNELL M ECKERT LSW” Practice Location

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