Provider Demographics
NPI:1184770497
Name:SERVAIS, DENISE C (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:C
Last Name:SERVAIS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 MARQUESS TRL N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-4402
Mailing Address - Country:US
Mailing Address - Phone:651-439-1766
Mailing Address - Fax:
Practice Address - Street 1:5035 MARQUESS TRL N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-4402
Practice Address - Country:US
Practice Address - Phone:651-439-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist