Healthcare Provider Details

I. General information

NPI: 1790617116
Provider Name (Legal Business Name): BETH BELLOWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3764 95TH AVE NE
CIRCLE PINES MN
55014-3849
US

IV. Provider business mailing address

6519 UPPER 14TH ST N
OAKDALE MN
55128-4519
US

V. Phone/Fax

Practice location:
  • Phone: 651-415-6224
  • Fax:
Mailing address:
  • Phone: 651-285-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: