Provider Demographics
NPI:1407009400
Name:GARAAS, JENNIFER M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:GARAAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WEST BEATON DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3468
Mailing Address - Country:US
Mailing Address - Phone:701-356-1276
Mailing Address - Fax:701-356-4940
Practice Address - Street 1:102 WEST BEATON DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3468
Practice Address - Country:US
Practice Address - Phone:701-356-4940
Practice Address - Fax:701-356-4940
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407009400OtherHEALTHPARTNERS
MN1407009400Medicaid
1407009400OtherPREFERRED ONE
ND10007Medicaid
MN142P5GAOtherBCBS MN
ND1407009400OtherBCBS ND
2677508OtherCIGNA
MN1407009400Medicaid