LACEY GEBRO (NPI# 1417409665) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417409665 |
| Entity Type | Individual |
| Full Name | LACEY GEBRO |
| Practice Address |
2624 9th Ave S Fargo ND 58103-2350 |
| Practice Telephone | 7012984500 |
| Practice Fax Number | 7012984400 |
| Mailing Telephone | 7012984500 |
| Mailing Fax Number | 7012984400 |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-11-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
2624 9TH AVE S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-2350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245284850 | Southeast Human Service Center | Clinic/Center | 2624 9th Ave S, Fargo, ND 58103-2350 | 2006-05-19 |
| 1750982120 | Lena Fogel | Counselor | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-11-03 |
| 1356956247 | Carmen Berg | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-09-09 |
| 1225643125 | Heidi Ottmar | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-09-09 |
| 1962011239 | Tayler Wilson | Registered Nurse | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-23 |
| 1023626595 | Jordan Solheim | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-21 |
| 1710595954 | Carissa Bertsch | Registered Nurse | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-14 |
| 1740898923 | Madeline Swanson | Social Worker | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-14 |
| 1821615394 | Tanner Valnes | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-01 |
| 1447876446 | Rachael Steinke | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-06-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
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| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053655795 | Dr. R Twardowski Md PC | Case Manager/Care Coordinator | 1842 14th St S Apt 4, Fargo, ND 58103-4842 | 2012-11-19 |
| 1801915426 | Monica J. Miller | Case Manager/Care Coordinator | 461 34th St S Ste C, Fargo, ND 58103-2215 | 2007-03-28 |
| 1942807904 | Carmel Froemke | Case Manager/Care Coordinator | 3911 20th Ave S, Fargo, ND 58103-4705 | 2020-10-02 |
| 1710584958 | Ashley Marie Littlewolf | Case Manager/Care Coordinator | 3233 University Dr S, Fargo, ND 58104-6221 | 2020-10-01 |
| 1356956247 | Carmen Berg | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-09-09 |
| 1225643125 | Heidi Ottmar | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-09-09 |
| 1023626595 | Jordan Solheim | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-21 |
| 1821615394 | Tanner Valnes | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-07-01 |
| 1447876446 | Rachael Steinke | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-06-25 |
| 1851914006 | Amber Herbranson | Case Manager/Care Coordinator | 2624 9th Ave S, Fargo, ND 58103-2350 | 2020-05-22 |
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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.