Healthcare Provider Details

I. General information

NPI: 1669710257
Provider Name (Legal Business Name): SADIE LYNN NORSTREM SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 10TH AVE NE ESSENTIA HEALTH DEER RIVER
DEER RIVER MN
56636-8795
US

IV. Provider business mailing address

115 10TH AVE NE ESSENTIA HEALTH DEER RIVER
DEER RIVER MN
56636-8795
US

V. Phone/Fax

Practice location:
  • Phone: 218-246-2900
  • Fax:
Mailing address:
  • Phone: 218-246-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8666
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: