| Rebecca Kopp Dunham Pllc | |
|
6046 14th St S Fargo ND 58104-7340 | |
| (701) 404-0997 | |
| (701) 566-8876 |
| Full Name | Rebecca Kopp Dunham Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 6046 14th St S, Fargo, North Dakota |
| Authorized Official Name and Position | Rebecca Kopp Dunham (PRESIDENT) |
| Authorized Official Contact | 7017155214 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rebecca Kopp Dunham Pllc 6046 14th St S Fargo ND 58104-7340 Ph: (701) 404-0997 | Rebecca Kopp Dunham Pllc 6046 14th St S Fargo ND 58104-7340 Ph: (701) 404-0997 |
| NPI Number | 1386235190 |
|---|---|
| Provider Enumeration Date | 02/03/2021 |
| Last Update Date | 10/05/2021 |
| Certification Date | 10/05/2021 |
| Medicare PECOS PAC ID | 8022424407 |
|---|---|
| Medicare Enrollment ID | O20210309003096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386235190 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rebecca Marie Kopp Dunham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659600054 PECOS PAC ID: 9931235868 Enrollment ID: I20160831001259 |
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