Contact

6709 1/2 Hwy 200

Carrington, ND 58421

701-786-6077 (CALL or TEXT)

701-786-6099

Contact Name

Phone Number

Email

Patient AGE

Service(s) Being Requested

School Contracts

Screenings | Consults

Evals & Interventions

Case Management

SLP Mentorship (Students & CFs)

Speaking Engagement

Area(s) of Concern (if applicable)

Speech

Language

Oral Motor | Oromyofunctional Disorders

Feeding/Swallowing

Provide any details: (e.g. speaking location, observations, questions, etc.)

Preferred Contact Method *

Call

Text

Email

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P: (701)-786-6077

F: (701)-786-6099

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