Healthcare Provider Details

I. General information

NPI: 1992739262
Provider Name (Legal Business Name): KEN J STONE PSY D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 UNIVERSITY DR S
FARGO ND
58103-4940
US

IV. Provider business mailing address

1720 UNIVERSITY DR S
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 701-461-5600
  • Fax: 701-461-5649
Mailing address:
  • Phone: 701-461-5600
  • Fax: 701-461-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberND 244
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number244
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: