Individual
THOMAS JOHN LIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-1065
Mailing address
3517 42ND AVE S, MINNEAPOLIS, MN 55406-2812
(715) 204-7881
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9682
MN
Other
Enumeration date
09/25/2017
Last updated
09/25/2017
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