Provider Demographics
NPI:1013254994
Name:BELGARDE, JERILYN
Entity Type:Individual
Prefix:
First Name:JERILYN
Middle Name:
Last Name:BELGARDE
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:PO BOX 1970
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-1970
Mailing Address - Country:US
Mailing Address - Phone:701-477-0525
Mailing Address - Fax:701-477-0527
Practice Address - Street 1:152 JOHN NORQUAY ST.
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-1970
Practice Address - Country:US
Practice Address - Phone:701-477-0525
Practice Address - Fax:701-477-0527
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4476104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker