| Fond Du Lac Reservation Business Committee | |
|
927 Trettle Lane Fond Du Lac Human Services Division Cloquet MN 55720 | |
| (218) 879-1227 | |
| (218) 878-3800 |
| Full Name | Fond Du Lac Reservation Business Committee |
|---|---|
| Speciality | Clinic/Center |
| Location | 927 Trettle Lane, Cloquet, Minnesota |
| Authorized Official Name and Position | Marilyn Grover (ASSOCIATE DIRECTOR) |
| Authorized Official Contact | 2188791227 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fond Du Lac Reservation Business Committee 927 Trettle Lane Fond Du Lac Human Services Division Cloquet MN 55720 Ph: (218) 879-1227 | Fond Du Lac Reservation Business Committee 927 Trettle Lane Fond Du Lac Human Services Division Cloquet MN 55720 Ph: (218) 879-1227 |
| NPI Number | 1326053166 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 02/02/2016 |
| Medicare PECOS PAC ID | 6608775879 |
|---|---|
| Medicare Enrollment ID | O20040107000308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326053166 | NPI | - | NPPES |
| 666815100 | Medicaid | MN | |
| 666815101 | Medicaid | MN | |
| 8F27FO | Other | MN | BCBS AODA |
| Provider Name | Jonathan P Gervais |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1427093475 PECOS PAC ID: 4082506654 Enrollment ID: I20040407000586 |
| Provider Name | Jeanne A Rice |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1205090321 PECOS PAC ID: 5597730309 Enrollment ID: I20040830000506 |
| Provider Name | Jennifer R Boyle |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1073582375 PECOS PAC ID: 8921074345 Enrollment ID: I20040908000244 |
| Provider Name | Magdalena Cecilia Reynolds-allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114914769 PECOS PAC ID: 7315916558 Enrollment ID: I20040925000044 |
| Provider Name | Gregory Scott Ash |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1275614463 PECOS PAC ID: 7810950409 Enrollment ID: I20041104000920 |
| Provider Name | David O Jorde |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396710174 PECOS PAC ID: 9537127444 Enrollment ID: I20041223000183 |
| Provider Name | Patrick F Boyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669427894 PECOS PAC ID: 3173526035 Enrollment ID: I20060814000400 |
| Provider Name | Betsy Ann Nelson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1386654812 PECOS PAC ID: 0446254379 Enrollment ID: I20060908000123 |
| Provider Name | Joey D Vork |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235319427 PECOS PAC ID: 9739269929 Enrollment ID: I20071228000468 |
| Provider Name | Suzanne Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386838712 PECOS PAC ID: 6204916430 Enrollment ID: I20071231000120 |
| Provider Name | Steven N Lukovsky |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1316082613 PECOS PAC ID: 2567544968 Enrollment ID: I20080124000143 |
| Provider Name | Marla A Dewitt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164640918 PECOS PAC ID: 3072668680 Enrollment ID: I20090903000470 |
| Provider Name | Arne Vainio |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013904655 PECOS PAC ID: 8426188798 Enrollment ID: I20100612000045 |
| Provider Name | Lynne M Kosmach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154318798 PECOS PAC ID: 2860517356 Enrollment ID: I20100921001073 |
| Provider Name | Lorraine L Turner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669469680 PECOS PAC ID: 9032303417 Enrollment ID: I20101029000599 |
| Provider Name | Kathryn D Roufs |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326352535 PECOS PAC ID: 1850587387 Enrollment ID: I20101123001034 |
| Provider Name | Jeffrey T Leno |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1316245608 PECOS PAC ID: 1557545654 Enrollment ID: I20110414000564 |
| Provider Name | Charles M Kendall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558358507 PECOS PAC ID: 2365619244 Enrollment ID: I20120117000582 |
| Provider Name | Jennifer S Hall |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1700962768 PECOS PAC ID: 8426225350 Enrollment ID: I20120118000396 |
| Provider Name | Mollie A Stapleton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912961228 PECOS PAC ID: 5294902714 Enrollment ID: I20120124000196 |
| Provider Name | Kirsten M Kortesma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053644765 PECOS PAC ID: 6709034309 Enrollment ID: I20120924000009 |
| Provider Name | Roxie L Wefel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952699944 PECOS PAC ID: 5193975092 Enrollment ID: I20121031000413 |
| Provider Name | Amanda M Murray |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1396002291 PECOS PAC ID: 0143472928 Enrollment ID: I20121129000450 |
| Provider Name | Christine Rose Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700253903 PECOS PAC ID: 7810207057 Enrollment ID: I20151030001042 |
| Provider Name | Anna Rosenberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700243243 PECOS PAC ID: 6204131840 Enrollment ID: I20160219001164 |
| Provider Name | Maureen L Randall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447609425 PECOS PAC ID: 2062704216 Enrollment ID: I20160707001923 |
| Provider Name | James Francis Conniff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639462997 PECOS PAC ID: 9830313048 Enrollment ID: I20161206000065 |
| Provider Name | Kiara Margaret Krugler Levar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356751531 PECOS PAC ID: 8628396827 Enrollment ID: I20171017003053 |
| Provider Name | Philip Douglas Knese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225534977 PECOS PAC ID: 1153676333 Enrollment ID: I20180611002459 |
| Provider Name | Leann Mae Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598246142 PECOS PAC ID: 8123379047 Enrollment ID: I20180915000008 |
| Provider Name | Charity A Reynolds |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912344722 PECOS PAC ID: 0042593006 Enrollment ID: I20181030002619 |
| Provider Name | Shane Richardson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659710374 PECOS PAC ID: 4981987807 Enrollment ID: I20181120000528 |
| Provider Name | Kelly Lynn Burgner |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326698531 PECOS PAC ID: 8224460357 Enrollment ID: I20191112000471 |
| Provider Name | Mary June Owen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801947320 PECOS PAC ID: 5597667113 Enrollment ID: I20191204003137 |
| Provider Name | Grace Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497117105 PECOS PAC ID: 4981035235 Enrollment ID: I20200520003308 |
| Provider Name | Jeanne Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881133668 PECOS PAC ID: 3971934233 Enrollment ID: I20200521000136 |
| Provider Name | Sarah Michelle Carlson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700313558 PECOS PAC ID: 2668890641 Enrollment ID: I20200909000430 |
| Provider Name | Andrew Elliott |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629046222 PECOS PAC ID: 2365542024 Enrollment ID: I20210630000874 |
| Provider Name | Amanda Marie Dornhecker |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1245907195 PECOS PAC ID: 8921406612 Enrollment ID: I20211011001782 |
| Provider Name | Amanda Lyn Sundin |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1518105352 PECOS PAC ID: 0244621944 Enrollment ID: I20220106000157 |
| Provider Name | Katie Mae Jorgensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366105637 PECOS PAC ID: 9931592755 Enrollment ID: I20220131001091 |
| Provider Name | Kari Stroik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033877501 PECOS PAC ID: 3971983727 Enrollment ID: I20220711001518 |
| Provider Name | Justin B Marty |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1366073827 PECOS PAC ID: 9234511015 Enrollment ID: I20220727001560 |
| Provider Name | Ellise Caroline Braveheart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275930026 PECOS PAC ID: 8729459581 Enrollment ID: I20230115000011 |
| Provider Name | Luke Abraham Tervola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609405240 PECOS PAC ID: 2961873138 Enrollment ID: I20230126000446 |
| Provider Name | Mckala Kaitlin Crotteau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942931944 PECOS PAC ID: 6507239795 Enrollment ID: I20230309001213 |
| Provider Name | Brooke Terasa Bond |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1114505989 PECOS PAC ID: 4587025846 Enrollment ID: I20230802003212 |
| Provider Name | Ryan Dunkley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184251019 PECOS PAC ID: 5294158614 Enrollment ID: I20230921002296 |
| Provider Name | Joellyn Steele |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1467902304 PECOS PAC ID: 1052760931 Enrollment ID: I20240111004552 |
| Provider Name | Lindsey Saukko |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1528589488 PECOS PAC ID: 6002250222 Enrollment ID: I20240215002893 |
| Provider Name | Joseph Curran |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972976215 PECOS PAC ID: 0840634705 Enrollment ID: I20240219002671 |
| Provider Name | Rebekah Rud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851986970 PECOS PAC ID: 2769823954 Enrollment ID: I20240520001062 |
| Provider Name | Marie Gibson Adebisi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437636297 PECOS PAC ID: 2365984333 Enrollment ID: I20240605001863 |
| Provider Name | Steffan Immerfall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396595302 PECOS PAC ID: 1254877376 Enrollment ID: I20240725001738 |
| Provider Name | Kevin Randa |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023854809 PECOS PAC ID: 4880131820 Enrollment ID: I20240807004187 |
| Provider Name | Taylor Beckenbach |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1023813425 PECOS PAC ID: 9032632229 Enrollment ID: I20250328000624 |
| Provider Name | Stephen Sabourin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295912889 PECOS PAC ID: 7618028762 Enrollment ID: I20250423000868 |
| Provider Name | Serge Sicular |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326276866 PECOS PAC ID: 0941442958 Enrollment ID: I20250423000924 |
| Provider Name | Shihshiang Cheng |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154511756 PECOS PAC ID: 6608928502 Enrollment ID: I20250423001077 |
| Provider Name | James Bolton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699725457 PECOS PAC ID: 7416951223 Enrollment ID: I20250423002167 |
| Provider Name | Phillip Triantos |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104821297 PECOS PAC ID: 9931003035 Enrollment ID: I20250423002626 |
| Provider Name | Monik Lala |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194847038 PECOS PAC ID: 9830264290 Enrollment ID: I20250423002780 |
| Provider Name | Michael Nicholas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942486873 PECOS PAC ID: 3678629995 Enrollment ID: I20250423003066 |
| Provider Name | Abhimanyu Aggarwal |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447605704 PECOS PAC ID: 7618365511 Enrollment ID: I20250424000929 |
| Provider Name | Monish Merchant |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609187186 PECOS PAC ID: 9436444320 Enrollment ID: I20250609000665 |
| Provider Name | Joel Szymanski |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497135974 PECOS PAC ID: 3779895198 Enrollment ID: I20250609000905 |
| Provider Name | Zachary Redus |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1831325307 PECOS PAC ID: 7911146915 Enrollment ID: I20250613000489 |
Aspenridge Chiropractic Center P.a. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2511 Washington Ave, Cloquet, MN 55720 Phone: 218-879-5831 | |
St. Luke's Hospital Of Duluth Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 707 Highway 33 S Ste 19, Cloquet, MN 55720 Phone: 218-879-4641 | |
The Duluth Clinic Ltd Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1413 Highway 33 S, Cloquet, MN 55720 Phone: 218-337-4000 Fax: 218-337-4001 |