Provider Demographics
NPI:1104025725
Name:CARLSTROM, JANE ELIZABETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELIZABETH
Last Name:CARLSTROM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 PILLSBURY DRIVE S.E.
Mailing Address - Street 2:115 SHEVLIN HALL
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0279
Mailing Address - Country:US
Mailing Address - Phone:612-624-7307
Mailing Address - Fax:612-624-7586
Practice Address - Street 1:164 PILLSBURY DRIVE S.E.
Practice Address - Street 2:115 SHEVLIN HALL
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0279
Practice Address - Country:US
Practice Address - Phone:612-624-7307
Practice Address - Fax:612-624-7586
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5032231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist