Provider Information for 1861639049
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LINDA LEE PAGENKOPF L.I.C.S.W.
Sex: Female
NPI: 1861639049
Last Updated: 2018-08-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1861639049 | ||||||||
| Enumeration Date | 2009-01-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2903 15TH ST S MOORHEAD, MN 56560-5111 United States Phone: 218-331-2032 | Fax: | ||||||||
| Primary Practice Address | 2903 15TH ST S MOORHEAD, MN 56560 United States Phone: 218-331-2032 | Fax: | ||||||||
| Secondary Practice Address(es) | 28908 80TH AVE S | ||||||||
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