Individual
MERRILL FAHLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
683 STATE AVE STE B, DICKINSON, ND 58601-4660
(701) 483-9400
(701) 483-9398
Mailing address
683 STATE AVE STE B, DICKINSON, ND 58601-4660
(701) 483-9400
(701) 483-9398
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
248
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19349
BLUE CROSS
ND
05
—
59563
—
ND
Enumeration date
09/27/2006
Last updated
07/08/2007
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