Jackmon, Wallace J

Jackmon, Wallace J is an individual health care provider with primary practice located at 4400 W 69Th St Ste 1500, Sioux Falls SD 57108-8170. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Jackmon, Wallace J can be contacted via phone (605) 322-5700.

Contact Information

Primary practice address
4400 W 69Th St Ste 1500 Sioux Falls SD 57108-8170
Phone: (605) 322-5700
Fax: (605) 322-5704
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 477 South Dakota

Profile Details

NPI number 1427020957
LBN Legal business name Jackmon, Wallace J
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 7th, 2006
Last updated Oct 11th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427020957 NPPES
North Dakota MEDICAID 12200
North Dakota MEDICAID 46022474352
North Dakota Other 854000
North Dakota MEDICAID 944611700
North Dakota Other 0040537
North Dakota Other 140M8JA
North Dakota Other 142415
North Dakota Other 412991020844
North Dakota MEDICAID 6552790
North Dakota MEDICAID 6570753
North Dakota Other 800013808
North Dakota Other HP37115
North Dakota Other 15096
North Dakota Other 20814
North Dakota MEDICAID 3989442
North Dakota Other 57108C003
North Dakota Other 9205351
North Dakota Other 040121002

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