Healthcare Provider Details

I. General information

NPI: 1588593792
Provider Name (Legal Business Name): WENDY SUE NELSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 HANCOCK ST SE
BECKER MN
55308-9526
US

IV. Provider business mailing address

10780 30TH ST
CLEAR LAKE MN
55319-9787
US

V. Phone/Fax

Practice location:
  • Phone: 763-261-6330
  • Fax:
Mailing address:
  • Phone: 320-291-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number429712
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: