Organization
PRAIRIE ST. JOHN'S CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY W MAGNISON CFO (CHIEF FINANCIAL OFFICER)
(701) 476-7221
Entity
Organization
Contact information
Practice address
7616 CURRELL BLVD, SUITE 100, SAINT PAUL, MN 55125-2290
(651) 259-9700
(651) 259-9740
Mailing address
510 4TH ST S, PO BOX 2027, FARGO, ND 58103-1914
(701) 476-7221
(701) 476-7261
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
5063A
ND
101YM0800X
Mental Health Counselor
5063A
ND
103T00000X
Psychologist
5063A
ND
103TB0200X
Cognitive & Behavioral Psychologist
5063A
ND
103TC1900X
Counseling Psychologist
5063A
ND
103TC2200X
Clinical Child & Adolescent Psychologist
5063A
ND
104100000X
Social Worker
Primary
5063A
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
238T5PR
MINNESOTA BLUE CROSS
MN
Enumeration date
09/28/2006
Last updated
09/11/2025
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