Individual
JILLENE SUSAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED. S., NCSP
Contact information
Practice address
444 4TH ST W, DICKINSON, ND 58601-4951
(701) 456-0002
Mailing address
444 4TH ST W, DICKINSON, ND 58601-4951
(701) 456-0002
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
417190
ND
Other
Enumeration date
10/24/2024
Last updated
10/24/2024
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