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Individual

MELISSA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW, LMSW

Contact information

Practice address
6706 54TH AVE S, FARGO, ND 58104-4579
(620) 224-7893
Mailing address
6706 54TH AVE S, FARGO, ND 58104-4579

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6598
ND

Other

Enumeration date
10/12/2023
Last updated
10/12/2023
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