# MR. DAVID A JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1801853775
- **Gender:** Man
- **Credential:** PHD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 359 | ND | Yes |

## Other

- **Enumeration date:** 04/26/2006
- **Last updated:** 09/07/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 12028 | — | ND |
| 05 | — | 169230500 | — | MN |
| 01 | — | 22269 | ND BC/BS | ND |
| 01 | — | 65F61JA | MN BC/BS | MN |