Watnemo, Larry Jerome
Watnemo, Larry Jerome is an individual health care provider with primary practice located at 1112 Nodak Dr S , Fargo ND 58103-2366. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Watnemo, Larry Jerome can be contacted via phone (701) 232-6224.Contact Information
Primary practice address
1112 Nodak Dr S
Fargo ND 58103-2366
Phone: (701) 232-6224
Fax: (701) 232-4687
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | ND 392-12-1-97-83 | North Dakota |
Profile Details
| NPI number | 1063568301 |
|---|---|
| LBN Legal business name | Watnemo, Larry Jerome |
| Credentials | LPCC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 27th, 2007 |
| Last updated | May 20th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063568301 | NPPES |
| North Dakota | MEDICAID | 1468231 |
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