| I Am Incorporated | |
|
403 4th St Nw Ste 115 Bemidji MN 56601-3155 | |
| (218) 214-9389 | |
| (218) 517-2034 |
| Full Name | I Am Incorporated |
|---|---|
| Speciality | Social Worker |
| Location | 403 4th St Nw Ste 115, Bemidji, Minnesota |
| Authorized Official Name and Position | Deonne M. Williams (CFO) |
| Authorized Official Contact | 2182149389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| I Am Incorporated 403 4th St Nw Ste 115 Bemidji MN 56601-3155 Ph: (218) 214-9389 | I Am Incorporated 403 4th St Nw Ste 115 Bemidji MN 56601-3155 Ph: (218) 214-9389 |
| NPI Number | 1215601422 |
|---|---|
| Provider Enumeration Date | 08/03/2021 |
| Last Update Date | 02/06/2023 |
| Certification Date | 02/06/2023 |
| Medicare PECOS PAC ID | 2365826740 |
|---|---|
| Medicare Enrollment ID | O20220902001421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215601422 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Deonne Marie Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689817751 PECOS PAC ID: 9032591417 Enrollment ID: I20220902001549 |
| Provider Name | Jeffrey Scott Widner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114668829 PECOS PAC ID: 0446623540 Enrollment ID: I20230309002067 |
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