Active NPI
Susan Marie Fedo Rosvold, MA CCC SLP
- Speech-Language Pathologist
- Fargo, ND
National Provider Identifier
1740361450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5815
- Practice address
- 801 Broadway N
Fargo, ND 58102-3641 - Phone
- (701) 234-6970
- NPI assigned
- Oct 18, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 770154 | WI | |
| Speech-Language Pathologist | 235Z00000X | 5815 | MN | Primary |
| Speech-Language Pathologist | 235Z00000X | 1333 | ND |
Addresses
Primary practice location
801 Broadway N
Fargo, ND 58102-3641
Mailing address
801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-6970
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42707900 | Medicaid | WI | |
| ENROLLED | Medicaid | MN |
Other names 1
- Susan Marie Fedo
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5815 | MN | MD | Psychologist |
| 1333 | ND | MD | Occupational Therapist |
| 770154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412121600000",
"number": "1740361450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 BROADWAY N",
"city": "FARGO",
"state": "ND",
"postal_code": "581023641",
"telephone_number": "701-234-6970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 BROADWAY N",
"city": "FARGO",
"state": "ND",
"postal_code": "581023641",
"telephone_number": "701-234-6970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDO ROSVOLD",
"first_name": "SUSAN",
"middle_name": "MARIE",
"credential": "MA CCC SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-18",
"last_updated": "2014-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "770154",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "5815",
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ND",
"license": "1333",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42707900",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ENROLLED",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "FEDO",
"middle_name": "MARIE",
"credential": "MA CCC SLP",
"code": "1",
"type": "Former Name"
}
]
}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 Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.