Individual
KERRY DEAN BUCKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5622 34TH AVE S, FARGO, ND 58104-7879
(701) 237-0942
Mailing address
5622 34TH AVE S, FARGO, ND 58104-7879
(701) 306-9855
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5140
ND
Other
Enumeration date
05/08/2024
Last updated
05/08/2024
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