Provider Demographics
NPI:1447315320
Name:O'BRIEN, KAREN (LSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 13TH AVE W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4879
Mailing Address - Country:US
Mailing Address - Phone:701-227-7566
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:200 PULVER HALL
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58960-4857
Practice Address - Country:US
Practice Address - Phone:701-227-7566
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2833104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54523Medicaid
ND79200OtherSED CARE COORDINATOR