Provider Demographics
NPI:1124450556
Name:THOMPSON WIDMER, CARRIE LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNN
Last Name:THOMPSON WIDMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 KUNDERT ST
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-4205
Mailing Address - Country:US
Mailing Address - Phone:701-448-9225
Mailing Address - Fax:701-448-2056
Practice Address - Street 1:416 KUNDERT ST
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:ND
Practice Address - Zip Code:58575-4205
Practice Address - Country:US
Practice Address - Phone:701-448-9225
Practice Address - Fax:701-448-2056
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4938101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker