Provider Demographics
NPI:1255972428
Name:MARYNIK, JESSICA CATHERINE (LBSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CATHERINE
Last Name:MARYNIK
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 12TH AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2313
Mailing Address - Country:US
Mailing Address - Phone:701-478-2324
Mailing Address - Fax:
Practice Address - Street 1:2601 12TH AVE S STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2313
Practice Address - Country:US
Practice Address - Phone:701-478-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker