Individual
JESSICA LYNN GUSTIN DATHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
FARGO VA, 2101 ELM STREET, FARGO, ND 58102
(701) 239-3700
Mailing address
FARGO VA HCS, 2101 ELM ST. N, FARGO, ND 58102
(701) 239-3700
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
441
ND
Other
Enumeration date
07/09/2009
Last updated
07/02/2025
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