Individual
LISA FANFULIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
9048 PEONY LN N, MAPLE GROVE, MN 55311-4417
(763) 416-9313
(763) 416-4530
Mailing address
9048 PEONY LN N, MAPLE GROVE, MN 55311-4417
(763) 416-9313
(763) 416-4530
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8159
MN
Other
Enumeration date
04/23/2008
Last updated
04/23/2008
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