Carol Rae Mickelson, MS,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

5372 Issued in MN

Practice address

6 Pine Tree Dr
Arden Hills, MN 55112-3745

Phone

(651) 639-0942

NPI assigned

Apr 11, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

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.

• Associated Speech and Language Specialists LLC

  • Speech-Language Pathologist
  • St Paul, MN
  • NPI 1881636223
  Medicare reassignment NPD
• Associated Speech and Language

  • Hearing and Speech Clinic/Center
  • Arden Hills, MN
  • NPI 1003188749
  NPD (past)

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

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1922794221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2985 LEXINGTON AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131915",
            "telephone_number": "651-415-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 PINE TREE DR",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551123745",
            "telephone_number": "651-639-0942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "CAROL",
        "middle_name": "RAE",
        "credential": "MS,CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-11",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "5372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melody Jade McEvoy
• Grace Ann McNaughton
• Eyobed Melkamu
• Robert Richard Menge, MSW, LGSW
• Kennedy Menke
• Brianna Lee Miller
• Eleanore R. Miller
• Jason Edward Miller, MSW, LICSW
• Mara Colleen Miller
• Samantha Jane Miller

• Speech-Language Pathologist in Arden Hills, MN
• Providers in Arden Hills, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; 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.