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Individual

MS. CECELIA CHAREST BISTNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S., CCC

Contact information

Practice address
4910 SARATOGA LN N, PLYMOUTH, MN 55442-3014
(763) 550-1123
(763) 550-9502
Mailing address
4910 SARATOGA LN N, PLYMOUTH, MN 55442-3014
(763) 550-1123
(763) 550-9502

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5001
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4600783
MEDICA PROVIDER ID
MN
01
8G315BI
BLUE CROSS BLUE SHIELD
MN
Enumeration date
04/18/2007
Last updated
07/08/2007
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