Watnemo, Larry Jerome

Watnemo, Larry Jerome is an individual health care provider with primary practice located at 1112 Nodak Dr S , Fargo ND 58103-2366. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Watnemo, Larry Jerome can be contacted via phone (701) 232-6224.

Contact Information

Primary practice address
1112 Nodak Dr S Fargo ND 58103-2366
Phone: (701) 232-6224
Fax: (701) 232-4687
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X ND 392-12-1-97-83 North Dakota

Profile Details

NPI number 1063568301
LBN Legal business name Watnemo, Larry Jerome
Credentials LPCC
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 27th, 2007
Last updated May 20th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063568301 NPPES
North Dakota MEDICAID 1468231

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