Provider Demographics
NPI:1952756173
Name:PAULSEN, JODI LEIGH (LICSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LEIGH
Last Name:PAULSEN
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 1:412 GREAT OAK DR
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-2504
Mailing Address - Country:US
Mailing Address - Phone:320-529-0862
Mailing Address - Fax:320-654-8875
Practice Address - Street 1:412 GREAT OAK DRIVE
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-9807
Practice Address - Country:US
Practice Address - Phone:320-529-0862
Practice Address - Fax:320-654-8875
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22195104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker