NPIMap

Shanda Gwen Gaunt, MS CCC/SLP

Individual provider Active NPI Speech-Language Pathologist · Albertville, MN

NPI 1780127373 · NPPES record last updated Mar 9, 2020

Key facts

NPI
1780127373
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
7438 (MN)
Practice address
11091 Jasen Ave NE Suite 2
Courage Kenny Rehabilitation Institute Albertville Part
Albertville, MN 55301
Phone
(763) 744-4160
Fax
(763) 497-0679
NPI assigned
Nov 30, 2016
Sex
Female
Sole proprietor
Yes

Organizations & group practices 2

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
7438MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Past
since Mar 16, 2020		 Accepting new patients
Allina Health System Past
since Mar 16, 2020		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 7438 MN Yes

Addresses

Primary practice location

11091 Jasen Ave NE Suite 2
Courage Kenny Rehabilitation Institute Albertville Part
Albertville, MN 55301

Mailing address

5436 Kahler Drive NE
Albertville, MN 55301
Phone (763) 370-9860

Other providers in Albertville, MN

All providers in Albertville, MN · Speech-Language Pathologist in Minnesota

Sources for this page

Verify at the official NPI Registry.