Healthcare Provider Details

I. General information

NPI: 1144134644
Provider Name (Legal Business Name): MILL CITY SPEECH AND LANGUAGE SERVIVCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 BRUNSWICK AVE N
CRYSTAL MN
55422-2540
US

IV. Provider business mailing address

3338 BRUNSWICK AVE N
CRYSTAL MN
55422-2540
US

V. Phone/Fax

Practice location:
  • Phone: 612-481-8314
  • Fax:
Mailing address:
  • Phone: 612-481-8314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOCELYN WALSH
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 612-481-8314