Provider Demographics
NPI:1164295309
Name:MCDONNELL, NATASHA (LBSW)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:3369 39TH ST S STE 2
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7542
Mailing Address - Country:US
Mailing Address - Phone:701-532-1353
Mailing Address - Fax:701-532-1505
Practice Address - Street 1:3369 39TH ST S STE 2
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7542
Practice Address - Country:US
Practice Address - Phone:701-532-1353
Practice Address - Fax:701-532-1505
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29576104100000X
ND6049104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker