Individual
LISA LIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8401 XERXES AVE S, BLOOMINGTON, MN 55431-1631
(952) 806-8943
Mailing address
1350 W 106TH ST, BLOOMINGTON, MN 55431-4126
(952) 806-8943
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
01091357
MN
Other
Enumeration date
06/08/2026
Last updated
06/08/2026
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