Healthcare Provider Details

I. General information

NPI: 1700700705
Provider Name (Legal Business Name): ANGELA ENGEBRETSON MS/CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S SHERMAN ST
HOUSTON MN
55943-8653
US

IV. Provider business mailing address

2805 JACKSON ST
LA CROSSE WI
54601-6078
US

V. Phone/Fax

Practice location:
  • Phone: 507-896-5323
  • Fax:
Mailing address:
  • Phone: 608-769-4976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1043851
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: