Provider Demographics
NPI:1396846531
Name:JENKINS, DAWN BREMER (MSSW LICSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:BREMER
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSSW LICSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:BREMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW LICSW
Mailing Address - Street 1:RANGE MENTAL HEALTH CENTER PERPICH BUILDING
Mailing Address - Street 2:3203 W 3RD AVE
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746
Mailing Address - Country:US
Mailing Address - Phone:218-263-9237
Mailing Address - Fax:218-262-3150
Practice Address - Street 1:RANGE MENTAL HEALTH CENTER PERPICH BUILDING
Practice Address - Street 2:3203 W 3RD AVE
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-263-9237
Practice Address - Fax:218-262-3150
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN132691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN701183100Medicaid
MN800001582Medicare ID - Type Unspecified