Provider Demographics
NPI:1124206248
Name:DUCKWITZ, LINDA F (LICSW, LAC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:F
Last Name:DUCKWITZ
Suffix:
Gender:F
Credentials:LICSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:FORT TOTTEN
Mailing Address - State:ND
Mailing Address - Zip Code:58335-0398
Mailing Address - Country:US
Mailing Address - Phone:701-476-0497
Mailing Address - Fax:701-766-4878
Practice Address - Street 1:816 3RD AVE N
Practice Address - Street 2:
Practice Address - City:FORT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335-9998
Practice Address - Country:US
Practice Address - Phone:701-766-4236
Practice Address - Fax:701-766-4878
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1024101YA0400X
ND814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19182Medicaid
ND27600OtherBC/BS ND
ND27599OtherBC/BS ND