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NPI Code Detail

MEDICARE: JESSICA ROSANNE BISTODEAU

MEDICARE: JESSICA ROSANNE BISTODEAU
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
1235Z00000XSpeech-Language PathologistMN

General Provider Information

NPI Number : 1922951235
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ROSANNE BISTODEAU
Provider Business Mailing Address
First Line : 5252 37TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-2128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1250 W BROADWAY AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2533
Country : US
Telephone Number : 507-279-9202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2026
Last Update Date : 02/17/2026

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Directions to “ JESSICA ROSANNE BISTODEAU ” Practice Location

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