Provider Demographics
NPI:1942617873
Name:SWEDLUND, JODI
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:SWEDLUND
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 1:101 3RD AVENUE SW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702
Mailing Address - Country:US
Mailing Address - Phone:701-857-5286
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58707-0001
Practice Address - Country:US
Practice Address - Phone:701-858-3274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND252-02/072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer