Basic Information
| Provider Information | |||||||||
| NPI: | 1326697756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEREMER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ARLYNN | ||||||||
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| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5543 BLAISDELL AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554191918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125126795 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5868 BAKER RD | ||||||||
| Address2: | |||||||||
| City: | MINNETONKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553455903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527674200 | ||||||||
| FaxNumber: | 9527674211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2019 | ||||||||
| LastUpdateDate: | 09/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 10341 | MN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.