Individual
BERNARD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
207 MAIN AVE W, WEST FARGO, ND 58078-1725
(701) 499-1022
Mailing address
207 MAIN AVE W, WEST FARGO, ND 58078-1725
(701) 499-1022
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ND
Other
Enumeration date
01/10/2022
Last updated
01/10/2022
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