MEDICARE: ITS A PART OF PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1215626197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITS A PART OF PLLC

Provider Business Mailing Address
First Line	:	10134 BURGUNDY DR
Second Line	:
City	:	HORACE
State	:	ND
Zip	:	58047-9007
Country	:	US
Telephone Number	:	218-230-4529
Fax Number	:

Provider Business Practice Location Address
First Line	:	5147 44TH ST SOUTH
Second Line	:	OFFICE #5
City	:	FARGO
State	:	ND
Zip	:	58104-5810
Country	:	US
Telephone Number	:	701-369-3181
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND MENTAL HEALTH THERAPIST
Name	:	JORDYN A KOSKI
Credential	:	LCSW
Telephone Number	:	218-230-4529

Provider Enumeration Date	:	05/05/2023
Last Update Date	:	05/05/2023

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