Healthcare Provider Details

I. General information

NPI: 1174395453
Provider Name (Legal Business Name): BEYOND BRAIN INJURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7587 KIMBERLY LN
EDEN PRAIRIE MN
55346-4259
US

IV. Provider business mailing address

7587 KIMBERLY LN
EDEN PRAIRIE MN
55346-4259
US

V. Phone/Fax

Practice location:
  • Phone: 612-384-1007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE LAINHART
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, CCC-SLP, CBIS
Phone: 612-384-1007