Provider Demographics
NPI:1154546638
Name:JAHNER, KENNETH L (BSED)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:L
Last Name:JAHNER
Suffix:
Gender:M
Credentials:BSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 13TH AVE W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4879
Mailing Address - Country:US
Mailing Address - Phone:701-227-7551
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:300 13TH AVE W
Practice Address - Street 2:SUITE 1
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4879
Practice Address - Country:US
Practice Address - Phone:701-227-7551
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54523Medicaid