| NPI | 1306384649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MARIAN IVERSON Speech Language Pathologist 218-477-2385 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MN 5512) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |