Provider Demographics
NPI:1669734547
Name:SIMON, TESSA MAYE (MS)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:MAYE
Last Name:SIMON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:MAYE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1150 PRAIRIE PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3168
Mailing Address - Country:US
Mailing Address - Phone:701-356-7766
Mailing Address - Fax:701-356-7765
Practice Address - Street 1:1150 PRAIRIE PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3168
Practice Address - Country:US
Practice Address - Phone:701-356-7766
Practice Address - Fax:701-356-7765
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist