Provider Demographics
NPI:1699875625
Name:ANDERSON, CAROL ANN (SLP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:LIPETZKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1018 37TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6133
Mailing Address - Country:US
Mailing Address - Phone:218-790-1249
Mailing Address - Fax:
Practice Address - Street 1:1606 29TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5923
Practice Address - Country:US
Practice Address - Phone:701-261-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN465153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP48712OtherHEALTH PARTNERS
MN4600826OtherMEDICA
MN115G9ANOtherBLUE CROSS BLUE SHIELD
MNHP48712OtherHEALTH PARTNERS