Healthcare Provider Details

I. General information

NPI: 1841118700
Provider Name (Legal Business Name): KASEY NICOLE FORTMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 47TH AVE S
GRAND FORKS ND
58201-3405
US

IV. Provider business mailing address

2950 36TH AVE S APT A11
GRAND FORKS ND
58201-3546
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-2200
  • Fax:
Mailing address:
  • Phone: 218-280-0098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: