Provider Demographics
NPI:1821372947
Name:HUBRIG, JONI LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:LYNN
Last Name:HUBRIG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:LYNN
Other - Last Name:DANIELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-0605
Mailing Address - Country:US
Mailing Address - Phone:701-234-3100
Mailing Address - Fax:
Practice Address - Street 1:100 4TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1929
Practice Address - Country:US
Practice Address - Phone:701-234-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND45081041C0700X
MN153611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19292Medicaid
ND19292Medicaid
NDN717147Medicare PIN