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NPI Code Detail

MEDICARE: MS. MARY ANNE RAZIM-FITZSIMONS CCC-SLP

MEDICARE: MS. MARY ANNE RAZIM-FITZSIMONS CCC-SLP
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
1235Z00000XSpeech-Language Pathologist0446974MN

General Provider Information

NPI Number : 1780513812
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ANNE RAZIM-FITZSIMONS CCC-SLP
Provider Business Mailing Address
First Line : 11975 EVERGREEN ST NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-2431
Country : US
Telephone Number : 612-239-6747
Fax Number :
Provider Business Practice Location Address
First Line : 11975 EVERGREEN ST NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-2431
Country : US
Telephone Number : 612-239-6747
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2026
Last Update Date : 05/15/2026

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Directions to “ MS. MARY ANNE RAZIM-FITZSIMONS CCC-SLP” Practice Location

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