Healthcare Provider Details

I. General information

NPI: 1871420240
Provider Name (Legal Business Name): ANNA RUTLEDGE CORDIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA RUTLEDGE SMITH

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 11TH AVE SW
FOREST LAKE MN
55025
US

IV. Provider business mailing address

201 RIVER LANE CT
BROOKLYN PARK MN
55444-2222
US

V. Phone/Fax

Practice location:
  • Phone: 651-252-6729
  • Fax:
Mailing address:
  • Phone: 507-269-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number493216
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: