Provider Demographics
NPI:1235525502
Name:FERGUSON, NAOMI (LSW)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 B AVE W STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKOTA
Mailing Address - State:ND
Mailing Address - Zip Code:58344-7410
Mailing Address - Country:US
Mailing Address - Phone:701-247-2945
Mailing Address - Fax:701-247-2943
Practice Address - Street 1:210 B AVE W STE 104
Practice Address - Street 2:
Practice Address - City:LAKOTA
Practice Address - State:ND
Practice Address - Zip Code:58344-7410
Practice Address - Country:US
Practice Address - Phone:701-247-2945
Practice Address - Fax:701-247-2943
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5044171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator