Healthcare Provider Details

I. General information

NPI: 1629523857
Provider Name (Legal Business Name): ELIZABETH RENEE VIEHWEG M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 TIMBERLINE RD
MINNETONKA MN
55305-2046
US

IV. Provider business mailing address

11650 TIMBERLINE RD
MINNETONKA MN
55305-2046
US

V. Phone/Fax

Practice location:
  • Phone: 612-418-7444
  • Fax:
Mailing address:
  • Phone: 612-418-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number528805
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: