Individual
LYNAE NEILSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
35731 LAKE ST, COHASSET, MN 55721-2106
(208) 571-8630
Mailing address
35731 LAKE ST, COHASSET, MN 55721-2106
(208) 571-8630
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9815
MN
235Z00000X
Speech-Language Pathologist
SLP1066
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002265701
—
ID
01
—
130007
MEDICARE
ID
Enumeration date
10/23/2007
Last updated
10/20/2023
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