Provider Demographics
NPI:1285759944
Name:WEISE-BROWN, DANA KIMBERLY (MS)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:KIMBERLY
Last Name:WEISE-BROWN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ALTHEA LN
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7100
Mailing Address - Country:US
Mailing Address - Phone:952-938-3603
Mailing Address - Fax:952-224-1612
Practice Address - Street 1:1014 MAINSTREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7534
Practice Address - Country:US
Practice Address - Phone:952-224-0707
Practice Address - Fax:952-224-1612
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2024-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN560093600Medicaid
MNHP42849Medicare UPIN
MN386L1WEMedicare UPIN