Individual
MS. LISA MARIE ROTELIUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
500 UNIVERSITY AVENUE WEST, MINOT, ND 58707
(701) 858-3030
(701) 858-3032
Mailing address
500 UNIVERSITY AVENUE WEST, MINOT, ND 58707
(701) 858-3030
(701) 858-3032
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
773
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51180
—
ND
01
—
ROT26952
BCBS
ND
Enumeration date
12/19/2006
Last updated
07/08/2007
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