BENNETT LEITCH (NPI# 1629519418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629519418 |
| Entity Type | Individual |
| Full Name | BENNETT LEITCH |
| Practice Address |
4440 S Washington St Grand Forks ND 58201-7245 |
| Mailing Address |
1751 36th Ave S Grand Forks ND 58201-7281 |
| Practice Telephone | 7017327700 |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
727-16 | ND | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
4440 S WASHINGTON ST |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201-7245 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497846299 | Brenda K Hanson | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2006-09-27 |
| 1942832456 | Qin Du | Orthopaedic Surgery | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2020-02-12 |
| 1477036374 | Alexandra Webb | Audiologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-09-07 |
| 1538647722 | Rebecca Pulkrabek | Nurse Practitioner | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-07-31 |
| 1083100036 | Nicole Morgan | Nurse Practitioner | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-07-02 |
| 1760984892 | Todd Jensen | Specialist/Technologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-03-05 |
| 1093236267 | Agatha J Ottem Lill | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-06-28 |
| 1699214387 | Altru Health System | Clinic/Center | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-02-15 |
| 1548654585 | Megan Nicole Kipp | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2015-03-27 |
| 1720428519 | Mark Strand | Otolaryngology | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2013-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1225523004 | Alicia Mae Mack | Registered Nurse | 212 S. 4th St. Suite 301, Spectra Health, Grand Forks, ND 58201 | 2018-06-25 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| Find all providers in zip 58201 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043851686 | Young Men's Christian Association of Grand Forks | Specialist/Technologist | 215 N 7th St, Grand Forks, ND 58203-3668 | 2019-10-04 |
| 1306301932 | Sydney Larson | Specialist/Technologist | 2008 Cottonwood St, Grand Forks, ND 58201-7366 | 2019-02-07 |
| 1295203537 | Abigail Grace Sistad | Specialist/Technologist | 520 N 7th St, Grand Forks, ND 58203-3243 | 2018-11-05 |
| 1205339025 | Katie Espe | Specialist/Technologist | 1712 Cottonwood St, Grand Forks, ND 58201-7360 | 2018-03-18 |
| 1720435134 | Cameron Nichols | Specialist/Technologist | 1301 N Columbia Rd Stop 9037, Grand Forks, ND 58202-9037 | 2016-05-16 |
| 1215305990 | Estephania Nunez | Specialist/Technologist | 3450 Ruemmele Rd, Apt 112, Grand Forks, ND 58201-6072 | 2015-09-11 |
| 1528452687 | Janelle Berg | Specialist/Technologist | 2113 5th Ave N, Grand Forks, ND 58203-2923 | 2015-03-26 |
| 1588058218 | Darci Wendeborn | Specialist/Technologist | 3900 S 11th St, Apt 213, Grand Forks, ND 58201-7376 | 2015-03-19 |
| 1871987594 | Rachel Dreibelbeis | Specialist/Technologist | 2202 11th Ave N, Grand Forks, ND 58203-2225 | 2015-03-19 |
| 1689068306 | Spencer Mccormick | Specialist/Technologist | 2208 11th Ave N, Grand Forks, ND 58203-2225 | 2015-03-19 |
| Find all providers in GRAND FORKS | ||||
| City | GRAND FORKS |
| Zip Code | 58201 |
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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.