Provider Demographics
NPI:1225355977
Name:WONG, KARA LYN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LYN
Last Name:WONG
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:LYN
Other - Last Name:BORNETUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:10600 THOMAS AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3722
Mailing Address - Country:US
Mailing Address - Phone:612-599-3342
Mailing Address - Fax:
Practice Address - Street 1:10201 WAYZATA BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5507
Practice Address - Country:US
Practice Address - Phone:612-599-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist