Healthcare Provider Details

I. General information

NPI: 1457063687
Provider Name (Legal Business Name): VONTEDDU ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 LYNDALE AVE S
BLOOMINGTON MN
55420-3502
US

IV. Provider business mailing address

9065 LYNDALE AVE S
BLOOMINGTON MN
55420-3502
US

V. Phone/Fax

Practice location:
  • Phone: 952-395-3326
  • Fax: 952-395-3556
Mailing address:
  • Phone: 952-395-3326
  • Fax: 952-395-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNI VONTEDDU
Title or Position: CEO
Credential:
Phone: 612-965-8349