Active NPI
Andrea Pauline Nelson, MA CCC-SLP
- Speech-Language Pathologist
- Minneapolis, MN
National Provider Identifier
1457492944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7683
- 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
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 | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 683S6NE | Other | MN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250501002060 | MN | Practitioner - Qualified Speech Language Pathologist | 3779009865 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7683 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of Minnesota | Current | Accepting new patients | |
| Regents of the University of Minnesota | Current | Accepting new patients | |
| Regents of the University of Minnesota | Speech-Language Pathologist | Current | Accepting new patients |
| Fraser | Past | Accepting new patients | |
| Fraser Child and Family Center | Past | 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.
-
dba Community-University Health Care Center
- Federally Qualified Health Center (FQHC)
- Minneapolis, MN
- NPI 1114019858
-
- Audiologist
- Minneapolis, MN
- NPI 1427243484
Speech-Language Pathologist
-
dba Boynton Health Service
- Clinic Pharmacy
- Minneapolis, MN
- NPI 1528288875
-
- Rehabilitation Clinic/Center
- Richfield, MN
- NPI 1063568574
-
- Adolescent and Children Mental Health Clinic/Center
- Minneapolis, MN
- NPI 1609922194
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.