Provider Demographics
NPI:1619358850
Name:QUANRUD, ALEXANDRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:QUANRUD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5559 MADISON CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3243
Mailing Address - Country:US
Mailing Address - Phone:612-720-8449
Mailing Address - Fax:
Practice Address - Street 1:2512 S WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6772
Practice Address - Country:US
Practice Address - Phone:701-333-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist