Provider Demographics
NPI:1366958308
Name:EXPRESSION SPEECH THERAPY
Entity type:Organization
Organization Name:EXPRESSION SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ZIEGELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:701-330-0911
Mailing Address - Street 1:1543 GRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2016
Mailing Address - Country:US
Mailing Address - Phone:701-330-0911
Mailing Address - Fax:701-772-1377
Practice Address - Street 1:309 HILL AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1033
Practice Address - Country:US
Practice Address - Phone:701-330-0911
Practice Address - Fax:701-772-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty