Jackson Luther

NPI Registration Record

Provider / OrganizationNPIDate Certified
JACKSON LUTHER11448974632021-06-06

Jackson Luther is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1144897463. Registration indicates Jackson Luther is a provider of services with a specialization in Behavioral Health & Social Service Providers, Behavior Technician (Behavior Technician, Behavioral Health & Social Service Providers) (Behavior Technician, )

Entity TypeIndividual
Provider Name Jackson Luther
Practice Office Address4140 RICHARD AVE STE 200
Practice Office Telephone2185145230
Mailing Address731 E 7TH ST APT 2
DULUTH, MN 558053411 US
Contact Endpoints
Other URL [][email protected]Direct
HPT Codes
License No
106S00000X PRIMARY
Behavioral Health & Social Service Providers
Behavior Technician
Behavior Technician
Behavioral Health & Social Service Providers
Behavior Technician
OPI Codes
1588993091 MEDICAID MN
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