Provider Demographics
NPI:1881672848
Name:NELSON, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 GOLF COURSE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8691
Mailing Address - Country:US
Mailing Address - Phone:218-454-3277
Mailing Address - Fax:218-454-3278
Practice Address - Street 1:14275 GOLF COURSE DR STE 220
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8691
Practice Address - Country:US
Practice Address - Phone:218-454-3277
Practice Address - Fax:218-454-3278
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN640000219Medicaid