Healthcare Provider Details

I. General information

NPI: 1295699387
Provider Name (Legal Business Name): S & S SPA SALON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 12TH ST SW
FOREST LAKE MN
55025-3778
US

IV. Provider business mailing address

280 12TH ST SW
FOREST LAKE MN
55025-3778
US

V. Phone/Fax

Practice location:
  • Phone: 651-464-6612
  • Fax: 651-982-0374
Mailing address:
  • Phone: 612-464-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMBER KUNZ
Title or Position: MASSAGE THERAPIST
Credential: LMT
Phone: 651-464-6612