Healthcare Provider Details

I. General information

NPI: 1891628418
Provider Name (Legal Business Name): TAYLOR LEA KRANTZ SPEECH THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR NASE SPEECH THERAPIST

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 RAVEN ST NW
COON RAPIDS MN
55433-3011
US

IV. Provider business mailing address

184 HIGH ST STE 701
BOSTON MA
02110-3025
US

V. Phone/Fax

Practice location:
  • Phone: 763-506-4800
  • Fax:
Mailing address:
  • Phone: 866-600-7598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1045484
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: