Provider Demographics
NPI:1164070942
Name:STRANGE, JEREMY ALLEN
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALLEN
Last Name:STRANGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 JEFFERSON ST SE APT 1
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3249
Mailing Address - Country:US
Mailing Address - Phone:320-455-6336
Mailing Address - Fax:
Practice Address - Street 1:965 JEFFERSON ST SE APT 1
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3249
Practice Address - Country:US
Practice Address - Phone:320-455-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty