Active NPI
Lynae Neilsen, MS
- Speech-Language Pathologist
- Cohasset, MN
National Provider Identifier
1841489010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 9815
- Practice address
- 35731 Lake St
Cohasset, MN 55721-2106 - Phone
- (208) 571-8630
- NPI assigned
- Oct 23, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP1066 | ID | |
| Speech-Language Pathologist | 235Z00000X | 9815 | MN | Primary |
Addresses
Primary practice location
35731 Lake St
Cohasset, MN 55721-2106
Mailing address
35731 Lake St
Cohasset, MN 55721-2106
Phone (208) 571-8630
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002265701 | Medicaid | ID | |
| 130007 | Other | ID | MEDICARE |
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9815 | MN | MD | Dentist |
| SLP1066 | ID | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697760000000",
"number": "1841489010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35731 LAKE ST",
"city": "COHASSET",
"state": "MN",
"postal_code": "557212106",
"telephone_number": "208-571-8630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35731 LAKE ST",
"city": "COHASSET",
"state": "MN",
"postal_code": "557212106",
"telephone_number": "208-571-8630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEILSEN",
"first_name": "LYNAE",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-23",
"last_updated": "2023-10-20",
"certification_date": "2023-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "SLP1066",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "9815",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002265701",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "130007",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cohasset, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.