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General NPI Number Information
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NPI Number | 1427245372
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Entity Type | Organization
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Legal Business Name | JACKSON W LIND LLC
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 2301 25TH ST S SUITE I
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City | FARGO
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State | ND
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Zip | 58103-6104
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Country | US
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Telephone | 701-241-9300
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Fax | 701-235-4525
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Provider Business Mailing Address
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Address Line | 2301 25TH ST S SUITE I
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City | FARGO
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State | ND
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Zip | 58103-6104
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Country | US
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Telephone | 701-241-9300
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Fax | 701-235-4525
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACKSON W LIND
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Credential | M.D.
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Telephone | 701-241-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 2756
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License Number State | ND
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