Basic Information
| Provider Information | |||||||||
| NPI: | 1477848117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEIDL | ||||||||
| FirstName: | BOBBI | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 25TH ST S | ||||||||
| Address2: | PO BOX 9859 | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581032311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014514900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4133 IOWA ST | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563083316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3207628851 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2011 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 45197 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.