Individual
MARJORIE CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
6936 GARLAND LN N, MAPLE GROVE, MN 55311-4642
(763) 416-9313
(763) 416-4530
Mailing address
6936 GARLAND LN N, MAPLE GROVE, MN 55311-4642
(763) 416-9313
(763) 416-4530
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9186
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9186
STATE OF MN
MN
Enumeration date
12/27/2013
Last updated
12/27/2013
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