Luther, Jackson
Luther, Jackson is an individual health care provider with primary practice located at 4140 Richard Ave Ste 200 , Hermantown MN 55811-3309. He recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as his primary health care specialty. Luther, Jackson can be contacted via phone (218) 514-5230.Contact Information
Primary practice address
4140 Richard Ave Ste 200
Hermantown MN 55811-3309
Phone: (218) 514-5230
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavior Technician | 106S00000X | Minnesota |
Profile Details
| NPI number | 1144897463 |
|---|---|
| LBN Legal business name | Luther, Jackson |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 6th, 2021 |
| Last updated | Feb 25th, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144897463 | NPPES |
| Minnesota | MEDICAID | 1588993091 |
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