Provider Demographics
NPI:1134549264
Name:KIZIMA, JENNIFER (LICSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KIZIMA
Suffix:
Gender:F
Credentials:LICSW
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 3339
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-3339
Mailing Address - Country:US
Mailing Address - Phone:701-720-7733
Mailing Address - Fax:
Practice Address - Street 1:600 22ND AVE NW STE B4
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-0986
Practice Address - Country:US
Practice Address - Phone:701-720-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4454104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker