Provider Demographics
NPI:1972524585
Name:SCHWARTZ, SHONDA L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SHONDA
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SHONDA
Other - Middle Name:L
Other - Last Name:FREITAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 13TH AVE W STE 1
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4875
Mailing Address - Country:US
Mailing Address - Phone:701-227-7514
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:200 PULVER HALL
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4878
Practice Address - Country:US
Practice Address - Phone:701-227-7514
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND29641041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54523Medicaid
ND23497OtherBCBS
ND79057OtherCARE COORDINATOR
ND54523Medicaid