Doctor Name: | MISS JESSICA LYNN WOLTERSTORFF |
NPI Number: | 1578797189 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA CF/SLP |
License Number: | 8422 |
Business Practice Address: | 11725 Stinson Ave Chisago City, MN - 550139542 |
Business Phone Number: | 6512578475 |
Business Fax Number: | 6512578437 |
Mailing Address: | 5200 Fairview Blvd, WYOMING |
State: | MN |
Postal Code: | 550928013 |
Phone Number: | 6512578475 |
Fax Number: | 6512578437 |
NPI Enumeration Date: | 05/11/2009 |
NPI Last Update Date: | 05/11/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 8422 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |