Individual
JAN KAREN WITTE-BAKKEN
Active
Individual
JAN KAREN WITTE-BAKKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2205
MN
103TC0700X
Clinical Psychologist
306
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11082
MEDICAID
ND
01
—
18691
BLUE CROSS
ND
05
—
505252100
—
MN
Enumeration date
10/03/2006
Last updated
02/24/2017
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