Provider Demographics
NPI:1790005619
Name:RAMBERG, JODI L (MA/LAC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:RAMBERG
Suffix:
Gender:F
Credentials:MA/LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 24TH AVE S STE 225
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6761
Mailing Address - Country:US
Mailing Address - Phone:701-317-5692
Mailing Address - Fax:
Practice Address - Street 1:1407 24TH AVE S STE 225
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6761
Practice Address - Country:US
Practice Address - Phone:701-317-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1623101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)