Provider Demographics
NPI:1447689617
Name:LAW, JOLENE MARIE CARLSON (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:MARIE CARLSON
Last Name:LAW
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15590 90TH ST NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-9452
Mailing Address - Country:US
Mailing Address - Phone:763-755-4275
Mailing Address - Fax:763-755-4261
Practice Address - Street 1:15590 90TH ST NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-9452
Practice Address - Country:US
Practice Address - Phone:763-755-4275
Practice Address - Fax:763-755-4261
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist