Provider Demographics
NPI:1225184971
Name:CARLSON, DEBRA MEINDL (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:MEINDL
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MEINDL
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3413 INTERLACHEN DR NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4511
Mailing Address - Country:US
Mailing Address - Phone:763-370-3028
Mailing Address - Fax:763-755-4261
Practice Address - Street 1:5861 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1653
Practice Address - Country:US
Practice Address - Phone:763-544-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNAO19510443880OtherPREFERRED ONE
MN46-00776OtherMEDICA
MN43-2036236OtherUNITED HEALTH CARE
MN73G76LEOtherBLUE CROSS BLUE SHIELD
MN861477600Medicaid
MNHP49339OtherHEALTHPARTNERS