Healthcare Provider Details

I. General information

NPI: 1255245742
Provider Name (Legal Business Name): RIC CALDWELL MA, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COUNTY ROAD B2 E
LITTLE CANADA MN
55117-1401
US

IV. Provider business mailing address

201 OAK PARK DR NE
BLAINE MN
55434-1944
US

V. Phone/Fax

Practice location:
  • Phone: 651-724-6621
  • Fax:
Mailing address:
  • Phone: 763-913-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number364867
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: