| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JACKSON LUTHER | 1144897463 | 2021-06-06 |
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 Type | Individual |
| Provider Name | Jackson Luther |
| Practice Office Address | 4140 RICHARD AVE STE 200 HERMANTOWN, MN US |
| Practice Office Telephone | 2185145230 |
| Mailing Address | 731 E 7TH ST APT 2 DULUTH, MN 558053411 US |
| Other URL [] | [email protected] | Direct |
| Code | Practice | License No State |
|---|---|---|
| 106S00000X PRIMARY | Behavioral Health & Social Service Providers Behavior Technician Behavior Technician Behavioral Health & Social Service Providers Behavior Technician |
MN |
| 1588993091 | MEDICAID | MN |