Organization
SANFORD CLINIC NORTH
Active
Other names
Sanford Neuroscience Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA K LECLERC (VP)
(701) 234-6248
Entity
Organization
Contact information
Practice address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4036
(701) 234-4134
Mailing address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4036
(701) 234-4134
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103T00000X
Psychologist
—
—
207T00000X
Neurological Surgery Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
648513800
—
MN
Enumeration date
07/25/2006
Last updated
11/27/2023
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