Individual
MARY KATHLEEN DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD CCCA
Contact information
Practice address
1104 7TH AVE SOUTH, MSUM BOX 119, MOORHEAD, MN 56563-0001
(218) 477-5953
(518) 477-4392
Mailing address
1104 7TH AVE SOUTH, MSUM BOX 119, MOORHEAD, MN 56563-0001
(218) 477-5953
(518) 477-4392
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
7305
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22624
BCBS
ND
01
—
426S9DR
BCBS
MN
05
—
54228
—
ND
Enumeration date
09/29/2006
Last updated
07/08/2007
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