Organization
MINNESOTA STATE UNIVERSITY-MOORHEAD
Active
Parent organization
MINNESOTA STATE COLLEGES AND UNIVERSITIES
Organization subpart
Yes
Provider details
NPI number
Legal business name
MINNESOTA STATE COLLEGES AND UNIVERSITIES
Authorized official
MRS. MICHELLE MARIAN IVERSON MS; CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(218) 477-2385
Entity
Organization
Contact information
Practice address
1104 7TH AVE S, MOORHEAD, MN 56563-0001
(218) 477-2385
Mailing address
1104 7TH AVE S, MOORHEAD, MN 56563-0001
(218) 477-2385
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
5512
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5512
MDE LICENSE
MN
Enumeration date
02/07/2017
Last updated
02/07/2017
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