Individual
GRANT STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5700 E RIVER RD, FRIDLEY, MN 55432-6149
(763) 571-3150
Mailing address
150 40TH ST SE, MONTEVIDEO, MN 56265-4085
(320) 226-4131
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
528350
MN
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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