Provider Demographics
NPI:1073631503
Name:HARTMAN, JESSICA KIMBERLY (LCSW/LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KIMBERLY
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LCSW/LICSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:16 RIVERVIEW LN SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-7000
Mailing Address - Country:US
Mailing Address - Phone:701-740-2658
Mailing Address - Fax:
Practice Address - Street 1:16 RIVERVIEW LN SE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-7000
Practice Address - Country:US
Practice Address - Phone:701-740-2658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND41141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical