Active NPI
Katelyn Loll
- Speech-Language Pathologist
- Fargo, ND
National Provider Identifier
1295256188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1583
- Practice address
- 4901 15TH Ave S
Fargo, ND 58103-8993 - Phone
- (701) 356-8360
- NPI assigned
- Jun 29, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1583 | ND | Primary |
Addresses
Primary practice location
4901 15TH Ave S
Fargo, ND 58103-8993
Mailing address
207 Main Ave W
West Fargo, ND 58078-1725
Phone (701) 356-2000
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1583 | ND | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737676800000",
"number": "1295256188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 MAIN AVE W",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580781725",
"telephone_number": "701-356-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4901 15TH AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581038993",
"telephone_number": "701-356-8360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOLL",
"first_name": "KATELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-29",
"last_updated": "2025-01-24",
"certification_date": "2025-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ND",
"license": "1583",
"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 Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.