MEDICARE: HALEY SUE NORDSKOG

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	1513	ND

General Provider Information

NPI Number	:	1568813525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY SUE NORDSKOG

Provider Business Mailing Address
First Line	:	3060 FRONTIER WAY S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-8909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 SIENNA DR S, STE 103
Second Line	:	STE 103
City	:	FARGO
State	:	ND
Zip	:	58104-5810
Country	:	US
Telephone Number	:	701-532-1906
Fax Number	:	701-532-1896

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

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	03/23/2021

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Directions to “ HALEY SUE NORDSKOG ” Practice Location

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