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General NPI Number Information
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NPI Number | 1790757573
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Entity Type | Individual
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Provider Name | IDA ADAMS MS-CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 314 MAIN ST E SUITE 3
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City | NEW PRAGUE
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State | MN
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Zip | 56071-2448
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Country | US
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Telephone | 952-758-5775
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Fax | 952-758-5778
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Provider Business Mailing Address
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Address Line | 30576 CEDAR LN
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City | LE SUEUR
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State | MN
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Zip | 56058-4346
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Country | US
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Telephone | 952-758-5775
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Fax | 952-758-5778
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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 | 5931
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License Number State | MN
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