Basic Information
| Provider Information | |||||||||
| NPI: | 1063584332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALLER | ||||||||
| FirstName: | LETTY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS,CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7420 MEADOW GRASS CV S | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550164590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517315189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 W 64TH ST | ||||||||
| Address2: | |||||||||
| City: | RICHFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554231001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127988329 | ||||||||
| FaxNumber: | 6128616050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7559 | MN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 044G9FA | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |