Individual
JACKIE MARIE LELM
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LICSW, MSW
Contact information
Practice address
1237 W DIVIDE AVE, STE 5, BISMARCK, ND 58501-1208
(701) 328-8843
(701) 328-8900
Mailing address
1237 W DIVIDE AVE, STE 5, BISMARCK, ND 58501-1208
(701) 328-8843
(701) 328-8900
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3132
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021924
BCBS OF ND PIN
—
01
—
N21924
RR MEDICARE
—
Enumeration date
06/13/2006
Last updated
07/09/2007
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