1376697441 NPI number — MS. SHEILA MARIE FROST MST, CCC SLP

Table of content: MS. SHEILA MARIE FROST MST, CCC SLP (NPI 1376697441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376697441 NPI number — MS. SHEILA MARIE FROST MST, CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FROST
Provider First Name:
SHEILA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MST, CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376697441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 PARK NICOLLET BLVD
Provider Second Line Business Mailing Address:
SPEECH DEPARTMENT
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-2527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-993-3036
Provider Business Mailing Address Fax Number:
952-993-1250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 PARK NICOLLET BLVD
Provider Second Line Business Practice Location Address:
SPEECH DEPARTMENT
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-993-3036
Provider Business Practice Location Address Fax Number:
952-993-1250
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  7362 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7362 . This is a "MN DEPARTMENT OF HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01093855 . This is a "ASHA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com