Jackson, David A

Jackson, David A is an individual health care provider with primary practice located at 3535 S 31St St Ste 201 , Grand Forks ND 58201-3593. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Jackson, David A can be contacted via phone (701) 780-6821.

Contact Information

Primary practice address
3535 S 31St St Ste 201 Grand Forks ND 58201-3593
Phone: (701) 780-6821
Fax: (701) 780-1973
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 359 North Dakota

Profile Details

NPI number 1801853775
LBN Legal business name Jackson, David A
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2006
Last updated Sep 7th, 2018 - about 6 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 1801853775 NPPES
Minnesota MEDICAID 169230500
Minnesota MEDICAID 12028
Minnesota Other 65F61JA
Minnesota Other 22269

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