| Doctor Name: | JAN KAREN WITTE-BAKKEN |
| NPI Number: | 1013001114 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 2205 |
| Business Practice Address: | 2624 9th Ave S Southeast Human Service Center Fargo, ND - 58103 |
| Business Phone Number: | 7012984500 |
| Business Fax Number: | 7012984400 |
| Mailing Address: | 2624 9th Ave S, Southeast Human Service Center FARGO |
| State: | ND |
| Postal Code: | 58103 |
| Phone Number: | 7012984500 |
| Fax Number: | 7012984400 |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 08/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2205 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |