Provider Demographics
NPI:1821579442
Name:HENDRICKSON, KARA MARIE (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 CREEK VIEW CIR SE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-8403
Mailing Address - Country:US
Mailing Address - Phone:763-486-2741
Mailing Address - Fax:
Practice Address - Street 1:300 CATLIN ST STE 101
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2035
Practice Address - Country:US
Practice Address - Phone:763-684-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist