Organization
SANFORD MEDICAL CENTER FARGO
Active
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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