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Individual
KELLY CARLSON
Active
Individual
KELLY CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MACCCSLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7663
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4600723
MEDICA
MN
01
—
964S0GI
BCBS
MN
01
—
HP42423
HEALTH PARTNERS
MN
Enumeration date
02/22/2007
Last updated
07/09/2007
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