Provider Demographics
NPI:1487940508
Name:DEKREY, CAROLINE ANNE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ANNE
Last Name:DEKREY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ANNE
Other - Last Name:BURKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6100 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPION
Mailing Address - State:MN
Mailing Address - Zip Code:55316
Mailing Address - Country:US
Mailing Address - Phone:701-739-1236
Mailing Address - Fax:
Practice Address - Street 1:2727 N. FERRY ST.
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303
Practice Address - Country:US
Practice Address - Phone:763-506-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist