Provider Demographics
NPI:1477272763
Name:NELSON, TESSA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 W VILLARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4632
Mailing Address - Country:US
Mailing Address - Phone:701-590-9116
Mailing Address - Fax:
Practice Address - Street 1:1340 W VILLARD ST STE A
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4632
Practice Address - Country:US
Practice Address - Phone:701-590-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist