Most Relevant Information
Provider Data
| NPI Number: | 1003063751 |
| Provider Name: | JONI LEA MEDENWALD MSW, LSW |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | 3977 |
Most Important Dates
| Enumeration Date: | 08/25/2008 |
| Last Updated: | 02/25/2020 |
Provider Practice Location
815 37TH AVE S
MOORHEAD
MN
565605524
Practice Location Phone/Fax
| Phone: | 7014514811 |
| Fax: | 6519250057 |
Provider Mailing Location
1201 25TH ST S
FARGO
ND
581032311
Provider Mailing Phone/Fax
| Phone: | 7014514900 |
| Fax: | 6519250057 |