Provider Demographics
NPI:1528198975
Name:MINOT STATE UNIVERSITY
Entity type:Organization
Organization Name:MINOT STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINARES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CCC-SLP
Authorized Official - Phone:701-858-3057
Mailing Address - Street 1:500 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58707-0001
Mailing Address - Country:US
Mailing Address - Phone:701-858-3030
Mailing Address - Fax:701-858-3032
Practice Address - Street 1:500 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58707-0001
Practice Address - Country:US
Practice Address - Phone:701-858-3030
Practice Address - Fax:701-858-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND231H00000X231H00000X
ND235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty