| Fraser, Ltd. | |
|
2902 University Dr S Fargo ND 58103-6053 | |
| (701) 232-3301 | |
| (701) 237-5775 |
| Full Name | Fraser, Ltd. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2902 University Dr S, Fargo, North Dakota |
| Authorized Official Name and Position | Amy Ann Hepper (DIRECTOR OF BUSINESS OPERATIONS) |
| Authorized Official Contact | 7012323301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fraser, Ltd. 2902 University Dr S Fargo ND 58103-6053 Ph: (701) 232-3301 | Fraser, Ltd. 2902 University Dr S Fargo ND 58103-6053 Ph: (701) 232-3301 |
| NPI Number | 1013285337 |
|---|---|
| Provider Enumeration Date | 12/01/2011 |
| Last Update Date | 10/19/2020 |
| Certification Date | 10/19/2020 |
| Medicare PECOS PAC ID | 0547563553 |
|---|---|
| Medicare Enrollment ID | O20160126001396 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013285337 | NPI | - | NPPES |
| 1770756041 | Medicaid | ND | |
| 1932313889 | Medicaid | ND | |
| 1730353574 | Medicaid | ND | |
| 1124292958 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Amanda Lindstrom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982081188 PECOS PAC ID: 0749590495 Enrollment ID: I20160408000020 |
| Provider Name | Kya M Duttenhefer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1437537750 PECOS PAC ID: 9133564057 Enrollment ID: I20240301002379 |
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