Individual
DAVID JEROME HARTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD PSYCHOLOGIST
Contact information
Practice address
1517 32ND AVE S, FARGO, ND 58103-5905
(701) 364-8000
Mailing address
PO BOX 6001, FARGO, ND 58103-6001
(701) 364-8000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1453
MN
103T00000X
Psychologist
Primary
167
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16939
—
ND
01
—
365250500
MEDICAID
MN
Enumeration date
09/07/2006
Last updated
07/21/2022
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