Organization
SANFORD MEDICAL CENTER FARGO
Active
Other names
Sanford Neuroscience Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA LECLERC (VICE PRESIDENT)
(701) 234-6248
Entity
Organization
Contact information
Practice address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4036
Mailing address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4036
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103T00000X
Psychologist
—
—
207T00000X
Neurological Surgery Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
08/18/2011
Last updated
11/27/2023
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