Basic Information
| Provider Information | |||||||||
| NPI: | 1093134207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | MONICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 2ND ST NE | ||||||||
| Address2: | |||||||||
| City: | NEW PRAGUE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560711709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527588957 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1025 MARSH ST | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560014752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076254031 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 9001 | MN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.