Healthcare Provider Details

I. General information

NPI: 1750626578
Provider Name (Legal Business Name): KATELYN PLOHASZ MS-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN ASTEDT

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 FAIRVIEW BLVD
WYOMING MN
55092-8013
US

IV. Provider business mailing address

20435 MONROE ST NE
CEDAR MN
55011-9418
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-7000
  • Fax:
Mailing address:
  • Phone: 763-670-5462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14051730
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: