Provider Demographics
NPI:1194950527
Name:WEBER, JOHN JOSEPH (LICSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:WEBER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 3RD ST NW
Mailing Address - Street 2:PO BOX 2055
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-2968
Mailing Address - Country:US
Mailing Address - Phone:701-253-6308
Mailing Address - Fax:701-253-6400
Practice Address - Street 1:520 3RD ST NW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2968
Practice Address - Country:US
Practice Address - Phone:701-253-6308
Practice Address - Fax:701-253-6400
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND38211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54521Medicaid