Provider Demographics
NPI:1407238470
Name:CAROL HASSEBROEK SPEECH PATHOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:CAROL HASSEBROEK SPEECH PATHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HASSEBROEK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:612-618-1040
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:612-610-1040
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty