Healthcare Provider Details

I. General information

NPI: 1417894700
Provider Name (Legal Business Name): CALLIE ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5575 FILLMORE ST NE
FRIDLEY MN
55432-5764
US

IV. Provider business mailing address

533 CHERI LN NE
FRIDLEY MN
55421-1252
US

V. Phone/Fax

Practice location:
  • Phone: 763-528-4321
  • Fax:
Mailing address:
  • Phone: 612-226-6925
  • 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: