Individual
MADELINE RUTH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1720 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 417-4493
Mailing address
1720 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 417-4493
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1603
ND
Other
Enumeration date
09/12/2017
Last updated
07/21/2022
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