Individual
MRS. JACKIE MIDGARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
830 W 15TH ST, GRAFTON, ND 58237-2055
(701) 352-1739
Mailing address
701 W 6TH ST, GRAFTON, ND 58237-1379
(701) 352-2574
(701) 352-0188
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
434
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58909
—
ND
Enumeration date
03/14/2007
Last updated
07/08/2007
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