Provider Demographics
NPI:1134282098
Name:PFEIFER, CAMIE LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:CAMIE
Middle Name:LYNN
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CAMI
Other - Middle Name:LYNN
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2409 W COUNTRY CLUB DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5738
Mailing Address - Country:US
Mailing Address - Phone:701-212-6968
Mailing Address - Fax:
Practice Address - Street 1:510 4TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1914
Practice Address - Country:US
Practice Address - Phone:701-476-7876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1459101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26489OtherBLUE CROSS BLUE SHIELD