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General NPI Number Information
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NPI Number | 1831280627
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Entity Type | Individual
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Provider Name | STACIA JANSSEN SLP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 450 SYNDICATE ST N
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City | SAINT PAUL
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State | MN
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Zip | 55104-4107
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Country | US
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Telephone | 763-689-5385
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Fax |
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Provider Business Mailing Address
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Address Line | 2744 RUSHMORE RD
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City | HASTINGS
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State | MN
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Zip | 55033-3752
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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 | 7828
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License Number State | MN
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