Provider Demographics
NPI:1407841489
Name:PURDY, MONICA MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:MARIE
Last Name:PURDY
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 1:6508 CHAMBERLAIN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2423
Mailing Address - Country:US
Mailing Address - Phone:651-470-1567
Mailing Address - Fax:866-457-7755
Practice Address - Street 1:490 HIGHWAY 96 W
Practice Address - Street 2:SUITE 300
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1960
Practice Address - Country:US
Practice Address - Phone:651-451-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN199G6PUOtherBLUE CROSS BLUE SHIELD
MN46-00866OtherMEDICA
MNHP39240OtherHEALTH PARTNERS