Provider Demographics
NPI:1255633244
Name:PELTIER, JONA RAE (LICSW)
Entity type:Individual
Prefix:
First Name:JONA
Middle Name:RAE
Last Name:PELTIER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JONA
Other - Middle Name:RAE
Other - Last Name:PARISIEN-PELTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1015 HOSPITAL RD. SUITE A
Mailing Address - Street 2:PO BOX 1149
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0160
Mailing Address - Country:US
Mailing Address - Phone:701-477-0455
Mailing Address - Fax:701-477-0457
Practice Address - Street 1:1015 HOSPITAL RD SUITE A
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0160
Practice Address - Country:US
Practice Address - Phone:701-477-0455
Practice Address - Fax:701-477-0457
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND45071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01063Medicaid
ND01063Medicaid