Provider Demographics
NPI:1194594333
Name:WALSH, JOCELYN (CCC-SLP, MED)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:CCC-SLP, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 FRANCE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3212
Mailing Address - Country:US
Mailing Address - Phone:612-481-8314
Mailing Address - Fax:
Practice Address - Street 1:3321 FRANCE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-3212
Practice Address - Country:US
Practice Address - Phone:612-481-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist