Smith, Kelly Craghill Fagerburg
Smith, Kelly Craghill Fagerburg is an individual health care provider with primary practice located at 1308 23Rd St S , Fargo ND 58103-3707. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Smith, Kelly Craghill Fagerburg can be contacted via phone (701) 297-7540.Contact Information
Primary practice address
1308 23Rd St S
Fargo ND 58103-3707
Phone: (701) 297-7540
Fax: (701) 297-6439
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 473 | North Dakota |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 473 | North Dakota |
Profile Details
| NPI number | 1376896803 |
|---|---|
| LBN Legal business name | Smith, Kelly Craghill Fagerburg |
| Credentials | PSYD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 22nd, 2012 |
| Last updated | Mar 11th, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376896803 | NPPES |
| North Dakota | MEDICAID | 17313 |
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