Active NPI
Marina Midthun, CCC-SLP
- Speech-Language Pathologist
- Maplewood, MN
National Provider Identifier
1932703782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 1705 Rosewood Ave S
Maplewood, MN 55109-3641 - Phone
- (715) 699-3893
- NPI assigned
- Nov 23, 2020
- Last updated
- Nov 23, 2020
- 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 | MN | Primary |
Addresses
Primary practice location
1705 Rosewood Ave S
Maplewood, MN 55109-3641
Mailing address
2110 Silver Bell Rd
Eagan, MN 55122-1024
Phone (651) 452-3499
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221008000209 | MN | Practitioner - Qualified Speech Language Pathologist | 4183000557 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606089600000",
"number": "1932703782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2110 SILVER BELL RD",
"city": "EAGAN",
"state": "MN",
"postal_code": "551221024",
"telephone_number": "651-452-3499",
"fax_number": "952-767-4211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1705 ROSEWOOD AVE S",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551093641",
"telephone_number": "715-699-3893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIDTHUN",
"first_name": "MARINA",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-23",
"last_updated": "2020-11-23",
"certification_date": "2020-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; 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.