Individual
JACQUELYN AUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
904 6TH AVENUE CT NE, ISANTI, MN 55040
(763) 444-8700
Mailing address
904 6TH AVENUE CT NE, ISANTI, MN 55040-3208
(763) 444-8700
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9331
MN
Other
Enumeration date
08/04/2014
Last updated
07/31/2018
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