Individual
RYAN D JAGIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
100 4TH ST S, FARGO, ND 58103-1929
(701) 234-4141
(701) 234-4024
Mailing address
100 4TH ST S, FARGO, ND 58103-1929
(701) 234-4141
(701) 234-4137
Taxonomy
Speciality
Code
Description
License number
State
103TP0814X
Psychoanalysis Psychologist
Primary
LP0537
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16915
—
ND
05
—
818548400
—
MN
Enumeration date
07/17/2006
Last updated
07/16/2010
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