MALLORY ELLEN IMBERG (NPI# 1174024095) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174024095 |
| Entity Type | Individual |
| Full Name | MALLORY ELLEN IMBERG |
| Credential | SLP |
| Practice Address |
5211 Highway 110 Aurora MN 55705-1522 |
| Mailing Address |
1702 University Dr S Fargo ND 58103-4940 |
| Practice Telephone | 2182293311 |
| Mailing Telephone | 7013644222 |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2018-02-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 235Z00000X | Speech-Language Pathologist | 9978 | MN | Speech, Language and Hearing Service Providers |
| Street Address |
5211 HIGHWAY 110 |
| City | AURORA |
| State | MN |
| Zip Code | 55705-1522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043285455 | Catherine Marie Mitchell | Family Medicine | 5211 Highway 110, Essentia Health Northern Pines Clinic, Aurora, MN 55705-1522 | 2006-02-20 |
| 1285183046 | Northern Pines Medical Center | Clinic/Center | 5211 Highway 110, Aurora, MN 55705-1522 | 2016-09-22 |
| 1932573177 | Emily Elizabeth Modin | Occupational Therapist | 5211 Highway 110, Aurora, MN 55705-1522 | 2015-11-28 |
| 1215321310 | Angela Boyd | Dietitian, Registered | 5211 Highway 110, Aurora, MN 55705-1522 | 2015-03-26 |
| 1497169056 | Tracy Powell | Registered Nurse | 5211 Highway 110, Aurora, MN 55705-1522 | 2014-06-11 |
| 1225467004 | Justin Peyla | Physical Therapist | 5211 Highway 110, Essentia Health-northern Pines, Aurora, MN 55705-1522 | 2013-11-02 |
| 1598105694 | Susan Elizabeth Stark | Nurse Practitioner | 5211 Highway 110, Essentia Heatlh Northern Pines Clinic, Aurora, MN 55705-1522 | 2013-07-03 |
| 1902243280 | Northern Pines Medical Center | Medicare Defined Swing Bed Unit | 5211 Highway 110, Aurora, MN 55705-1522 | 2013-05-28 |
| 1881954147 | Northern Pines Medical Center | Clinic/Center | 5211 Highway 110, Aurora, MN 55705-1522 | 2012-05-21 |
| 1891053567 | Northern Pines Medical Center | Non-Pharmacy Dispensing Site | 5211 Highway 110, Aurora, MN 55705-1522 | 2012-05-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144436189 | Mary Agnes Johnson | Technician | 705 Knuti Dr, Aurora, MN 55705 | 2007-05-15 |
| 1871651646 | Northern Pines Medical Center | Pharmacy | 5211 Hwy 110, Aurora, MN 55705 | 2006-12-05 |
| 1700997327 | Mark W Boback | Dentist | 22 W 3rd Ave N, Aurora, MN 55705 | 2006-08-31 |
| 1346252053 | Claude Erickson | Physician Assistant | 405 West 3rd Ave N, Aurora, MN 55705 | 2006-08-12 |
| 1780838151 | Vision Pro | Optometrist | 5211 Hwy 110, White Community Hospital, Aurora, MN 55705 | 2008-11-11 |
| 1982641791 | The Duluth Clinic, Ltd | Clinic/Center | 405 W 3rd Ave N, Box 392, Aurora, MN 55705-1247 | 2006-06-01 |
| 1447817978 | Mesabacare LLC | Counselor | 405 W 3rd Ave N, Aurora, MN 55705-1247 | 2019-05-21 |
| 1063704930 | Ann Marie Westbrook Vreeland | Nurse Practitioner | 405 W 3rd Ave N, Aurora, MN 55705-1247 | 2011-05-10 |
| 1811920564 | Michelle Renee Oman | Family Medicine | 405 W 3rd Ave N, Aurora, MN 55705-1247 | 2006-07-08 |
| 1457958498 | Carol Ruth Haasl | Community Health Worker | 215 W 4th Ave N, Aurora, MN 55705-1252 | 2020-10-02 |
| Find all providers in zip 55705 | ||||
| Taxonomy Code | 235Z00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Speech-Language Pathologist |
| The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing. |
| Notes: "Scope of Practice in Speech-Language Pathology", American Speech-Language-Hearing Association, 2013. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275145237 | Heather Coverdell | Speech-Language Pathologist | 1034 S Lincoln Ave, Aurora, MO 65605-1824 | 2020-08-20 |
| 1679182794 | Natalie Potter | Speech-Language Pathologist | 6051 S Andes Cir, Aurora, CO 80016-3837 | 2020-07-24 |
| 1194349464 | Chelsea Lee Brown | Speech-Language Pathologist | 12631 E 17th Ave Ste 3001, Aurora, CO 80045-2527 | 2020-06-02 |
| 1366080657 | Alexis Moreland | Speech-Language Pathologist | 10951 E Garden Dr, Aurora, CO 80012-4375 | 2019-12-17 |
| 1740828201 | Claire Marie Mcgovern | Speech-Language Pathologist | 2985 S Oakland St, Aurora, CO 80014-3143 | 2019-12-16 |
| 1619510427 | Kendra J Gill | Speech-Language Pathologist | 787 Meadowridge Dr, Aurora, IL 60504-5380 | 2019-10-24 |
| 1073160974 | Emily Nauman | Speech-Language Pathologist | 13123 E 16th Ave # B145, Aurora, CO 80045-7106 | 2019-08-25 |
| 1336792084 | Rachelle Paquette | Speech-Language Pathologist | 6795 S Langdale St Unit 209, Aurora, CO 80016-2873 | 2019-07-22 |
| 1740842707 | Samantha Leah-audra Ginsburg | Speech-Language Pathologist | 13837 E Greenwood Dr, Aurora, CO 80014-3919 | 2019-06-30 |
| 1841853983 | Camille Stewart | Speech-Language Pathologist | 13123 E 16th Ave # 30, Aurora, CO 80045-7106 | 2019-04-15 |
| Find all providers in AURORA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.