Individual
KRYSTA SEVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1606 29TH AVE S, FARGO, ND 58103-5923
(701) 261-4708
Mailing address
1410 21ST ST S, FARGO, ND 58103-3811
(701) 238-9433
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
938
ND
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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