Provider Demographics
NPI:1427101195
Name:STROMBECK, KELLY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:STROMBECK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12449 SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4523
Mailing Address - Country:US
Mailing Address - Phone:763-428-6486
Mailing Address - Fax:
Practice Address - Street 1:305 CEDAR ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8300
Practice Address - Country:US
Practice Address - Phone:763-228-7540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist