Healthcare Provider Details

I. General information

NPI: 1891610580
Provider Name (Legal Business Name): LISA AMY WEE SPEECH LANGUAGE PATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11408 ZION RD
BLOOMINGTON MN
55437-3634
US

IV. Provider business mailing address

3585 ELRENE RD
EAGAN MN
55123-1204
US

V. Phone/Fax

Practice location:
  • Phone: 402-936-0429
  • Fax:
Mailing address:
  • Phone: 402-936-0429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLICC-2420
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: