Provider Demographics
NPI:1881976249
Name:DAIGNEAULT, REBECCA DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DAWN
Last Name:DAIGNEAULT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 GREY EAGLE PASS
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1816
Mailing Address - Country:US
Mailing Address - Phone:701-340-4494
Mailing Address - Fax:
Practice Address - Street 1:2813 GREY EAGLE PASS
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1816
Practice Address - Country:US
Practice Address - Phone:701-340-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ND51041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty