Individual
SHANDA CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1200 S COLUMBIA RD, GRAND FORKS, ND 58201-4036
(701) 780-5000
Mailing address
1200 S COLUMBIA RD, GRAND FORKS, ND 58201-4036
(701) 780-5000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1510
ND
235Z00000X
Speech-Language Pathologist
9721
MN
Other
Enumeration date
08/04/2016
Last updated
08/04/2016
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