NPIMap

Organization Active NPI

Minnesota State University-Moorhead

  • Clinic/Center
  • Moorhead, MN
National Provider Identifier
1306384649
Registry record updated Feb 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
5512 Issued in MN
Legal business name
MINNESOTA STATE UNIVERSITY-MOORHEAD
Practice address
1104 7TH Ave S
Moorhead, MN 56563-0001
Phone
(218) 477-2385
NPI assigned
Feb 7, 2017
Organization subpart
Yes
Parent organization
MINNESOTA STATE COLLEGES AND UNIVERSITIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 7, 2017

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

Authorized official

Name
Mrs. Michelle Marian Iverson, MS; CCC-SLP
Title
Speech Language Pathologist
Phone
(218) 477-2385

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 5512 MN Primary

Addresses

Primary practice location

1104 7TH Ave S
Moorhead, MN 56563-0001

Mailing address

1104 7TH Ave S
Moorhead, MN 56563-0001
Phone (218) 477-2385

Other identifiers 1

IdentifierTypeStateIssuer
5512OtherMNMDE LICENSE

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Correctional Facility -Togo28 organizations share this tax ID, including this one
Part of
St Cloud State University

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486425600000",
    "number": "1306384649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 7TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565630001",
            "telephone_number": "218-477-2385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 7TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565630001",
            "telephone_number": "218-477-2385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA STATE UNIVERSITY-MOORHEAD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINNESOTA STATE COLLEGES AND UNIVERSITIES",
        "enumeration_date": "2017-02-07",
        "last_updated": "2017-02-07",
        "status": "A",
        "authorized_official_last_name": "IVERSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "MARIAN",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "218-477-2385",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS; CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "5512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDE LICENSE",
            "identifier": "5512",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; 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.