Healthcare Provider Details

I. General information

NPI: 1710213327
Provider Name (Legal Business Name): ELIZABETH ANNE DOUCETTE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 GALTIER ST
SAINT PAUL MN
55103-2358
US

IV. Provider business mailing address

2200 E 86TH ST APT 12
BLOOMINGTON MN
55425-2149
US

V. Phone/Fax

Practice location:
  • Phone: 651-224-1848
  • Fax:
Mailing address:
  • Phone: 507-412-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8560
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: