Individual
LISA KERSTIN CHANNON I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
666 WARNER AVE S, MAHTOMEDI, MN 55115-6882
(651) 407-2309
Mailing address
9 LACOSTA CIR, DELLWOOD, MN 55110-1223
(651) 407-2309
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
MN
Other
Enumeration date
03/27/2026
Last updated
03/27/2026
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