Organization
PROGRESSIVE THERAPY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODI LYNN HEDSTROM MS CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(701) 356-7766
Entity
Organization
Contact information
Practice address
825 28TH ST S STE B, FARGO, ND 58103-2325
(701) 356-7766
(701) 356-7765
Mailing address
825 28TH ST S STE B, FARGO, ND 58103-2325
(701) 356-7766
(701) 356-7765
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
8076
MN
235Z00000X
Speech-Language Pathologist
840
ND
235Z00000X
Speech-Language Pathologist
8674
MN
235Z00000X
Speech-Language Pathologist
Primary
957
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0DI79PR
BLUE CROSS BLUE SHIELD
MN
Enumeration date
11/02/2010
Last updated
01/14/2022
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