Provider Demographics
NPI:1497534796
Name:DUBORD, JASON DAVID
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:DUBORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ELM ST
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:ND
Mailing Address - Zip Code:58051-4005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 ELM ST
Practice Address - Street 2:
Practice Address - City:KINDRED
Practice Address - State:ND
Practice Address - Zip Code:58051-4005
Practice Address - Country:US
Practice Address - Phone:701-226-1506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND86941516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional