Individual
JASMINE OTTMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
6046 14TH ST S, FARGO, ND 58104-7340
(701) 404-0997
(701) 566-8876
Mailing address
6046 14TH ST S, FARGO, ND 58104-7340
(701) 209-0319
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
4446
ND
104100000X
Social Worker
4446
ND
1041C0700X
Clinical Social Worker
Primary
4446
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1471882
—
ND
Enumeration date
12/20/2011
Last updated
10/05/2021
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