MEDICARE: MINOT STATE UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	231H00000X	ND
2	235Z00000X	Speech-Language Pathologist	235Z00000X	ND

General Provider Information

NPI Number	:	1528198975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINOT STATE UNIVERSITY

Provider Business Mailing Address
First Line	:	500 UNIVERSITY AVE W
Second Line	:
City	:	MINOT
State	:	ND
Zip	:	58707-0001
Country	:	US
Telephone Number	:	701-858-3030
Fax Number	:	701-858-3032

Provider Business Practice Location Address
First Line	:	500 UNIVERSITY AVE W
Second Line	:
City	:	MINOT
State	:	ND
Zip	:	58707-0001
Country	:	US
Telephone Number	:	701-858-3030
Fax Number	:	701-858-3032

Authorized Official
Title or Position	:	DEPARTMENT CHAIR
Name	:	DR. THOMAS A. LINARES
Credential	:	PH.D. CCC-SLP
Telephone Number	:	701-858-3057

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	01/27/2017

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1710179312 — MS. CRYSTAL ULAT CCC-SLP MA
Practice Location Address:

500 UNIVERSITY AVE W
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1376722330 — JULIE A. DEFAZIO MS, CCC-SLP
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1023263035 — GERALDO B LIMA MS, CCC-SLP
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1265712558 — ANN M. BESTE-GULDBORG PH.D.
Practice Location Address:

500 UNIVERSITY AVE W
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58707-0001

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1053662239 — MINOT STATE UNIVERSITY
Practice Location Address:

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1295169365 — JENNA HORLACHER
Practice Location Address:

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Directions to “MINOT STATE UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

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