Individual provider Active NPI

Emily Rose Kunstleben

  • Speech-Language Pathologist
  • Fargo, ND
National Provider Identifier
1205214004
Registry record updated May 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
1415 Issued in ND
Practice address
3060 Frontier Way S
Fargo, ND 58104-8909
Phone
(701) 232-2340
NPI assigned
May 12, 2015
Last updated
May 12, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 1415 ND Primary

Addresses

Primary practice location

3060 Frontier Way S
Fargo, ND 58104-8909

Mailing address

30402 County Road 10
Albany, MN 56307-9404
Phone (320) 290-3672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1415NDMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431388800000",
    "number": "1205214004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30402 COUNTY ROAD 10",
            "city": "ALBANY",
            "state": "MN",
            "postal_code": "563079404",
            "telephone_number": "320-290-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3060 FRONTIER WAY S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048909",
            "telephone_number": "701-232-2340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNSTLEBEN",
        "first_name": "EMILY",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-12",
        "last_updated": "2015-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "1415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.