Minnesota State University-moorhead | |
1104 7th Ave S Moorhead MN 56563-0001 | |
(218) 477-2385 | |
Not Available |
Full Name | Minnesota State University-moorhead |
---|---|
Speciality | Clinic/center |
Location | 1104 7th Ave S, Moorhead, Minnesota |
Authorized Official Name and Position | Michelle Marian Iverson (SPEECH LANGUAGE PATHOLOGIST) |
Authorized Official Contact | 2184772385 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Minnesota State University-moorhead 1104 7th Ave S Moorhead MN 56563-0001 Ph: (218) 477-2385 | Minnesota State University-moorhead 1104 7th Ave S Moorhead MN 56563-0001 Ph: (218) 477-2385 |
NPI Number | 1306384649 |
---|---|
Provider Enumeration Date | 02/07/2017 |
Last Update Date | 02/07/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306384649 | NPI | - | NPPES |
5512 | Other | MN | MDE LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 5512 (Minnesota) | Primary |
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