Individual
MR. DAVID A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3535 S 31ST ST STE 201, GRAND FORKS, ND 58201-3593
(701) 780-6821
(701) 780-1973
Mailing address
3535 S 31ST ST STE 201, GRAND FORKS, ND 58201-3593
(701) 780-6821
(701) 780-1973
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
359
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12028
—
ND
05
—
169230500
—
MN
01
—
22269
ND BC/BS
ND
01
—
65F61JA
MN BC/BS
MN
Enumeration date
04/26/2006
Last updated
09/07/2018
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