Provider Demographics
NPI:1558458265
Name:NESS, TAMMY DAWN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:DAWN
Last Name:NESS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:DAWN
Other - Last Name:SWALLERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 20TH AVE SW STE 4
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6572
Mailing Address - Country:US
Mailing Address - Phone:701-720-8876
Mailing Address - Fax:
Practice Address - Street 1:104 20TH AVE SW STE 4
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6572
Practice Address - Country:US
Practice Address - Phone:701-720-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND028715OtherBLUE CROSS BLUE SHIELD
ND19192Medicaid
ND028715OtherBLUE CROSS BLUE SHIELD
NDN712708Medicare PIN