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General NPI Number Information
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NPI Number | 1740524016
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Entity Type | Individual
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Provider Name | CARMEN JO ANDERSON MS CCC SLP
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Gender | Female
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 2319 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55116-2813
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Country | US
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Telephone | 651-251-3078
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Fax |
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Provider Business Mailing Address
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Address Line | 2838 FREMONT AVE S UNIT 329
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2086
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8785
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License Number State | MN
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