MEDICARE: MRS. KENDALL MARIE CEDERSTROM M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	9528	MN

General Provider Information

NPI Number	:	1396120572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENDALL MARIE CEDERSTROM M.S.

Provider Business Mailing Address
First Line	:	420 QUINLAN AVE N
Second Line	:
City	:	LAKELAND
State	:	MN
Zip	:	55043-9494
Country	:	US
Telephone Number	:	651-245-2676
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 DELEWARE STREET SE
Second Line	:	MMC 106/MAYO B-414 UNIVERSITY OF MINNESOTA HEALTH,
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414
Country	:	US
Telephone Number	:	612-273-5961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	05/04/2026

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