Provider Demographics
NPI:1811457369
Name:MINNESOTA STATE COLLEGES AND UNIVERSITIES
Entity type:Organization
Organization Name:MINNESOTA STATE COLLEGES AND UNIVERSITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPART CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHOWALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CCC-SLP
Authorized Official - Phone:507-389-1415
Mailing Address - Street 1:150 SOUTH RD
Mailing Address - Street 2:317 CLINICAL SCIENCES BUILDING
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7046
Mailing Address - Country:US
Mailing Address - Phone:507-389-1414
Mailing Address - Fax:507-389-2821
Practice Address - Street 1:150 SOUTH RD
Practice Address - Street 2:116 CLINICAL SCIENCES BUILDING
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7046
Practice Address - Country:US
Practice Address - Phone:507-389-6298
Practice Address - Fax:507-389-2821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNESOTA STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-21
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center