Individual
KELLY BANISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, SLP
Contact information
Practice address
2080 36TH AVE SW STE 110, MINOT, ND 58701-7597
(701) 222-3175
(701) 222-3186
Mailing address
2304 8TH AVE NW, MINOT, ND 58703-1705
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1960
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1483044
—
ND
Enumeration date
07/13/2021
Last updated
09/22/2023
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