Provider Demographics
NPI:1659688034
Name:PLANKERS, MARIBETH KAY (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:KAY
Last Name:PLANKERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1104 7TH AVENUE SOUTH
Mailing Address - Street 2:MSUM BOX 119
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56563-0001
Mailing Address - Country:US
Mailing Address - Phone:218-477-2330
Mailing Address - Fax:218-477-4392
Practice Address - Street 1:1104 7TH AVENUE SOUTH
Practice Address - Street 2:MSUM
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56563-0001
Practice Address - Country:US
Practice Address - Phone:218-477-2330
Practice Address - Fax:218-477-4392
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist