JAN KAREN WITTE-BAKKEN (NPI# 1013001114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013001114 |
| Entity Type | Individual |
| Full Name | JAN KAREN WITTE-BAKKEN |
| Credential | PHD |
| Practice Address |
891 Belsly Blvd Moorhead MN 56560-5055 |
| Practice Telephone | 2182874338 |
| Practice Fax Number | 2182875928 |
| Mailing Telephone | 2182874338 |
| Mailing Fax Number | 2182875928 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2017-02-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
306 | ND | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
2205 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | BLUE CROSS | 18691 | 01 |
| ND | MEDICAID | 11082 | 01 |
| MN | 505252100 | 05 |
| Street Address |
891 BELSLY BLVD |
| City | MOORHEAD |
| State | MN |
| Zip Code | 56560-5055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508804543 | Rita Lall | Psychologist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2006-06-03 |
| 1619575065 | Faith Durham | Specialist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2020-10-16 |
| 1184222853 | Cassidy Schafer | Specialist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2020-10-14 |
| 1093313777 | Brady Amundson | Specialist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2020-10-14 |
| 1588262752 | Aida Zeba | Specialist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2020-10-11 |
| 1801494125 | Erika Weaver | Specialist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2020-10-09 |
| 1023615887 | Jennifer Ann Johnson | Specialist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2020-10-05 |
| 1356954432 | Sonam Lama | Specialist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2020-08-28 |
| 1396356655 | Morgan Nordheim | Specialist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2020-08-11 |
| 1356950703 | Mckenzie Lehmann | Specialist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2020-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386298859 | Anna Mckay Fox | Pharmacist | 4000 28th Avenue S, Moorhead, MN 56560 | 2019-08-01 |
| 1972019727 | Michael Wayne Hilliard | Specialist/Technologist | 649 17th St S, Moorhead, MN 56560 | 2017-12-15 |
| 1508217183 | Kristen Johnson | Nurse Practitioner | 801 Belsly Boulevard, Moorhead, MN 56560 | 2016-06-25 |
| 1861877052 | Midwest Mental Health Clinic | Nurse Practitioner | 819 30th Ave S Office 206 Suite B, Moorhead, MN 56560 | 2015-07-29 |
| 1083037709 | Drake Counseling Services, Inc. | Clinic/Center | 715 11th Street North, Suite 204, Moorhead, MN 56560 | 2014-01-31 |
| 1710310917 | Lamar Terrell Hill | Social Worker | 420 Center Ave Ste 102, Moorhead, MN 56560 | 2013-08-12 |
| 1982956140 | Lilac Homes Corporation | Assisted Living Facility | 2615 Parkview Dr, Moorhead, MN 56560 | 2012-10-11 |
| 1487918462 | Paige Joy Hanson | Massage Therapist | 805 14th St. So., Msum Wellness Center, Moorhead, MN 56560 | 2012-06-25 |
| 1972809408 | Cslm, LLC | Assisted Living Facility | 2401 South 11th Street, Moorhead, MN 56560 | 2011-02-01 |
| 1972814846 | Paul Michael Fluto | Pharmacist | 3000 Hwy 10 East, Mooehead, MN 56560 | 2010-06-25 |
| Find all providers in zip 56560 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497027841 | Joseph M Cox | Psychologist | 200 5th St S Ste 204, Moorhead, MN 56560-2768 | 2012-02-01 |
| 1811045255 | Von Karin King | Psychologist | 200 5th St S, 208, Moorhead, MN 56560-2768 | 2007-01-08 |
| 1023197522 | Carol Collette Follingstad | Psychologist | 1132 28th Ave S, Suite 102, Moorhead, MN 56560-4420 | 2006-11-03 |
| 1821182924 | Nancy Jo Hein-kolo | Psychologist | 1606 C 30th Ave S, Moorhead, MN 56560 | 2006-10-03 |
| 1013402429 | Juihsien Kao | Psychologist | 891 Belsly Blvd, Moorhead, MN 56560-5055 | 2018-06-27 |
| 1841338548 | Richard A Kolotkin Phd Pa | Psychologist | 403 Center Ave, Suite 601, Moorhead, MN 56560-1975 | 2007-02-02 |
| 1366591877 | Ronald Odden | Psychologist | 403 Center Ave, Moorhead, MN 56560-1975 | 2007-01-10 |
| 1184774622 | Access of The Red River Valley | Psychologist | 403 Center Ave, Moorhead, MN 56560-1975 | 2007-01-10 |
| 1487731014 | Denise M Duke | Psychologist | 420 Center Ave, Ste 5, Moorhead, MN 56560-1962 | 2006-11-01 |
| 1306930417 | Krislea Erin Wegner | Psychologist | 1606 C 30th Ave S, Moorhead, MN 56560 | 2006-10-03 |
| Find all providers in MOORHEAD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.