Provider Demographics
NPI:1932954476
Name:HARPESTAD, JADYN
Entity Type:Individual
Prefix:
First Name:JADYN
Middle Name:
Last Name:HARPESTAD
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 519
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0519
Mailing Address - Country:US
Mailing Address - Phone:701-953-7239
Mailing Address - Fax:701-477-5979
Practice Address - Street 1:212 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-7152
Practice Address - Country:US
Practice Address - Phone:701-953-7239
Practice Address - Fax:701-477-5979
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator