Provider Demographics
NPI:1376848440
Name:TANGEN, JODI LEIGH (DOCTORATE)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:LEIGH
Last Name:TANGEN
Suffix:
Gender:F
Credentials:DOCTORATE
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 6050
Mailing Address - Street 2:NORTH DAKOTA STATE UNIVERSITY
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1919 UNIVERSITY DR N
Practice Address - Street 2:NORTH DAKOTA STATE UNIVERSITY
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1843
Practice Address - Country:US
Practice Address - Phone:701-231-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health