Individual
JESSICA RAE CROATT NIEMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1426 BEMIDJI AVE N STE 1, BEMIDJI, MN 56601-3882
(218) 444-2233
(218) 237-2520
Mailing address
515 BRIDGE ST, PARK RAPIDS, MN 56470-1210
(218) 366-9229
(218) 237-2520
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
15124
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048937900
—
MN
01
—
201J8NI
BLUECROSSBLUESHIELD MN
MN
Enumeration date
05/01/2007
Last updated
06/16/2018
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