Jackson Luther

NPI #1144897463 in Hermantown, Minnesota

Provider Information

NPI Number: 1144897463
Entity Type: Individual
Name: Jackson Luther
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Jun 6, 2021
Last Updated: Feb 25, 2022

Practice Location

Address: 4140 RICHARD AVE STE 200
City: Hermantown
State: Minnesota
ZIP Code: 55811-3309
Phone: (218) 514-5230

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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