Healthcare Provider Details

I. General information

NPI: 1235333196
Provider Name (Legal Business Name): JILL RAE RENTMEESTER DISHER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W BROADWAY AVE STE 221
MINNEAPOLIS MN
55411-2533
US

IV. Provider business mailing address

4305 SEQUOIA DR
EAGAN MN
55122-1844
US

V. Phone/Fax

Practice location:
  • Phone: 612-668-5100
  • Fax:
Mailing address:
  • Phone: 612-668-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8028
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: