Christine Dotzenrod Childress

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

9472 Issued in MN

Practice address

15620 Edgewood Dr
Ste 240
Baxter, MN 56401-6983

Phone

(218) 454-7012

Fax

(218) 454-7015

NPI assigned

Feb 4, 2016

Last updated

Feb 4, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, ND2 enrollments

Enrollment records 2

Specialty

Qualified Speech Language Pathologist

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Total Balance Physical Therapy and Fitness, LLC

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  • NPI 1588175061

  MN, Speech-Language Pathologist

  Medicare reassignment NPD

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

{
    "created_epoch": "1454544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454544000000",
    "number": "1366800377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 WASHINGTON AVE",
            "city": "ORTONVILLE",
            "state": "MN",
            "postal_code": "562781357",
            "telephone_number": "320-839-4086",
            "fax_number": "320-839-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15620 EDGEWOOD DR",
            "address_2": "STE 240",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564016983",
            "telephone_number": "218-454-7012",
            "fax_number": "218-454-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOTZENROD CHILDRESS",
        "first_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-04",
        "last_updated": "2016-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "9472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael G Didier, PA-C
• Timothy Glenn Dirks, MD
• Esther Marie Doele, C-FNP
• Jeffrey Alan Donatelle
• Samantha Marie Doree
• Mary Margaret Doucette
• Dr. Jeanni R. Foss DDS LLC (Edgewood Dental)
• Brittnie Draeger
• Dreamhaven Dental Sleep Medicine
• Claudio Isidoro Duarte, M.D.

• Speech-Language Pathologist in Baxter, MN
• Providers in Baxter, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.