Provider Demographics
NPI:1720581663
Name:WUORI, JAIME (MS, LICSW)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:WUORI
Suffix:
Gender:F
Credentials:MS, LICSW
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 243
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-0243
Mailing Address - Country:US
Mailing Address - Phone:218-485-4445
Mailing Address - Fax:218-485-0477
Practice Address - Street 1:316 ELM AVE
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-7706
Practice Address - Country:US
Practice Address - Phone:218-485-4445
Practice Address - Fax:218-485-0477
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN247261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical