Provider Demographics
NPI:1396163028
Name:PAULSON, JANINNE LYNELL (LSW)
Entity type:Individual
Prefix:MS
First Name:JANINNE
Middle Name:LYNELL
Last Name:PAULSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JANINNE
Other - Middle Name:COLE
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:18 2ND AVE SE
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-0039
Mailing Address - Country:US
Mailing Address - Phone:701-628-2925
Mailing Address - Fax:701-628-3175
Practice Address - Street 1:18 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-0039
Practice Address - Country:US
Practice Address - Phone:701-628-2925
Practice Address - Fax:701-628-3175
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000079199Medicaid
ND2819OtherSW LICENSE