Provider Demographics
NPI:1609531466
Name:NEWBERGER, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:NEWBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 39TH ST S STE 2
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7542
Mailing Address - Country:US
Mailing Address - Phone:701-532-1353
Mailing Address - Fax:701-532-1505
Practice Address - Street 1:3369 39TH ST S STE 2
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7542
Practice Address - Country:US
Practice Address - Phone:701-532-1353
Practice Address - Fax:701-532-1505
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1163-10-15-21A101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional