Provider Demographics
NPI:1770676926
Name:ANDERSON, KATHRYN A (SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 LAKE ST S STE 300
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2681
Mailing Address - Country:US
Mailing Address - Phone:651-241-3840
Mailing Address - Fax:651-241-3733
Practice Address - Street 1:1467 LAKE ST S STE 300
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2681
Practice Address - Country:US
Practice Address - Phone:651-241-3840
Practice Address - Fax:651-241-3733
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP53310OtherHEALTHPARTNERS
MN188P7FROtherBCBS