Fundamental Kids Therapy LLC
Speech-Language Pathologist, in Shoreview, MN. Organization (NPI-2).
NPI number1922443522
StatusActive
Last updated in NPPESOct 17, 2021
Details
- NPI
- 1922443522
- Entity type
- Organization (NPI-2)
- Legal business name
- Fundamental Kids Therapy LLC
- Organization subpart
- No
- Enumeration date
- May 8, 2013
- Certification date
- Oct 17, 2021
- Last updated
- Oct 17, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | 8614 | MN | Yes |
| 225X00000X | Occupational Therapist | – | – |
Practice location
5985 Rice Creek Pkwy Ste 205Shoreview, MN 55126-5037
Phone 612-888-4757 · Fax 612-808-0005
Mailing address
5985 Rice Creek Pkwy Ste 205Shoreview, MN 55126-5037
Phone 612-888-4757 · Fax 612-808-0005
Other practice locations
12732 Lake Blvd
Lindstrom, MN 55045-9342
Lindstrom, MN 55045-9342
Phone 612-888-4757
Authorized official
Julie M Johnson
Owner
9522972460
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