Individual
CAROL RAE MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CCC-SLP
Contact information
Practice address
6 PINE TREE DR, ARDEN HILLS, MN 55112-3745
(651) 639-0942
Mailing address
2985 LEXINGTON AVE N, ROSEVILLE, MN 55113-1915
(651) 415-0440
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5372
MN
Other
Enumeration date
04/11/2023
Last updated
04/11/2023
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