| Redeeming Grace Counseling | |
|
1351 Page Dr S Fargo ND 58103-3502 | |
| (701) 353-9979 | |
| (701) 639-6501 |
| Full Name | Redeeming Grace Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 1351 Page Dr S, Fargo, North Dakota |
| Authorized Official Name and Position | Jennifer Lenore Anderson (PRESIDENT) |
| Authorized Official Contact | 7013539979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Redeeming Grace Counseling 1351 Page Dr S Ste 202 Fargo ND 58103-3536 Ph: (701) 353-9979 | Redeeming Grace Counseling 1351 Page Dr S Fargo ND 58103-3502 Ph: (701) 353-9979 |
| NPI Number | 1568930238 |
|---|---|
| Provider Enumeration Date | 11/11/2018 |
| Last Update Date | 07/01/2020 |
| Certification Date | 07/01/2020 |
| Medicare PECOS PAC ID | 9739429895 |
|---|---|
| Medicare Enrollment ID | O20190327002392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568930238 | NPI | - | NPPES |
| 12696273 | Other | CAQH | |
| N711952 | Other | MEDICARE | |
| 19344 | Medicaid | ND | |
| 1942625983 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jennifer Lenore Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942625983 PECOS PAC ID: 7719110436 Enrollment ID: I20140505001628 |
| Provider Name | Kenneth M Flanagan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326420936 PECOS PAC ID: 8729015292 Enrollment ID: I20150730013649 |
| Provider Name | Amy M Fox |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407187982 PECOS PAC ID: 6507204641 Enrollment ID: I20240409001025 |
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