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SANFORD CLINIC NORTH

Clinical Neuropsychologist

Fargo, North Dakota

Provider NPI: 1023030046

Organization Information:
Organization Name:  SANFORD CLINIC NORTH
Organization is not Subpart
Authorized Official:  MARTHA K LECLERC  VP  701-2346248

Practice Location:
700 1ST AVE S  FARGO, ND 58103 US
Tel: 701-234-4036  Fax: 701-234-4134

Business Mailing Address:
700 1ST AVE S  FARGO, ND 58103 US
Tel: 701-234-4036  Fax: 701-234-4134

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103T00000XBehavioral Health & Social Service Providers
Psychologist
N207T00000XPhysicians
Neurological Surgery
N2084N0400XPhysicians
Psychiatry & Neurology
N2084P0800XPhysicians
Psychiatry & Neurology
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist

Other Provider Identifiers:

IssuerNumberStateType
648513800MN05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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