Individual provider Active NPI

Andrea Pauline Nelson, MA CCC-SLP

  • Speech-Language Pathologist
  • Minneapolis, MN
National Provider Identifier
1457492944
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
7683 Issued in MN
Practice address
2400 W 64TH St
Minneapolis, MN 55423-1001
Phone
(612) 798-8330
Fax
(612) 861-1533
NPI assigned
Feb 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 7683 MN Primary

Addresses

Primary practice location

2400 W 64TH St
Minneapolis, MN 55423-1001

Mailing address

4708 Bloomington Ave
Minneapolis, MN 55407-3665
Phone (612) 825-1230

Other identifiers 1

IdentifierTypeStateIssuer
683S6NEOtherMNBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250501002060 MN Practitioner - Qualified Speech Language Pathologist 3779009865

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
7683MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Minnesota Current Accepting new patients
Regents of the University of Minnesota CurrentSince Mar 28, 2025 Accepting new patients
Regents of the University of Minnesota Speech-Language Pathologist CurrentSince Mar 28, 2025 Accepting new patients
Fraser Past Accepting new patients
Fraser Child and Family Center PastSince Oct 28, 2020 Accepting new patients

Locations

164 Pillsbury Dr SE
Minneapolis, MN 55455
Phone (612) 624-3322

164 Pillsbury Dr SE
#115
Minneapolis, MN 55455
Phone (612) 624-3322

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457492944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4708 BLOOMINGTON AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073665",
            "telephone_number": "612-825-1230",
            "fax_number": "612-861-1533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 W 64TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554231001",
            "telephone_number": "612-798-8330",
            "fax_number": "612-861-1533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "ANDREA",
        "middle_name": "PAULINE",
        "name_prefix": "Mrs.",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "7683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "683S6NE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.