Provider Demographics
NPI:1356658736
Name:HASSEBROEK, CAROL ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:HASSEBROEK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 W 36TH ST APT 206
Mailing Address - Street 2:#206
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2543
Mailing Address - Country:US
Mailing Address - Phone:612-618-1040
Mailing Address - Fax:
Practice Address - Street 1:5650 W 36TH ST APT 206
Practice Address - Street 2:#206
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2543
Practice Address - Country:US
Practice Address - Phone:612-618-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist