Individual
TINA FAUSETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
11455 VIKING DR, SUITE 300, EDEN PRAIRIE, MN 55344-7251
(952) 993-2498
(952) 993-2505
Mailing address
11455 VIKING DR, SUITE 300, EDEN PRAIRIE, MN 55344-7251
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7620
MN
Other
Enumeration date
07/01/2009
Last updated
07/01/2009
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