Healthcare Provider Details

I. General information

NPI: 1114857489
Provider Name (Legal Business Name): TIMOTHY MCCARREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ROYALS DR
MINNETONKA MN
55305-3123
US

IV. Provider business mailing address

1001 MN-7 #248
HOPKINS MN
55305
US

V. Phone/Fax

Practice location:
  • Phone: 952-988-5040
  • Fax:
Mailing address:
  • Phone: 952-988-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLICC-2838
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: