Provider Demographics
NPI:1225862444
Name:SABO, JACIE HELEN (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:JACIE
Middle Name:HELEN
Last Name:SABO
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2355
Mailing Address - Country:US
Mailing Address - Phone:701-595-6995
Mailing Address - Fax:
Practice Address - Street 1:128 SOO LINE DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3339
Practice Address - Country:US
Practice Address - Phone:701-595-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND67911041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool