Individual
CARRIE LATVALA JERYLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
13750 CROSSTOWN DR NW, SUITE 310, ANDOVER, MN 55304-5853
(763) 755-4275
(763) 755-4261
Mailing address
14060 AZTEC ST NW, ANDOVER, MN 55304-7443
(763) 422-1392
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6292
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131G3JE
BLUECROSSBLUESHIELD
MN
01
—
46-00854
MEDICA
MN
01
—
HP34823
HEALTHPARTNERS
MN
Enumeration date
01/30/2007
Last updated
07/08/2007
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