Provider Demographics
NPI:1174378459
Name:SLETTOM, ANNE
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:SLETTOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:KATOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14715 EDGEWOOD DR STE 5
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8687
Mailing Address - Country:US
Mailing Address - Phone:218-390-8303
Mailing Address - Fax:
Practice Address - Street 1:14715 EDGEWOOD DR STE 5
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8687
Practice Address - Country:US
Practice Address - Phone:218-416-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty