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Individual

KELLY L MONDRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
SLP

Contact information

Practice address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-3300
(701) 364-8906
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
758
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20604
NDBS #
ND
01
43G43MO
MNBS #
ND
01
4600417
MEDICA #
ND
01
4600418
MEDICA #
ND
05
52515
ND
01
HP33433
HEALTHPARTNERS #
ND
Enumeration date
07/10/2006
Last updated
07/09/2007
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