Healthcare Provider Details

I. General information

NPI: 1801728514
Provider Name (Legal Business Name): CLAIRE MCKISSICK M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17310 MINNETONKA BLVD
MINNETONKA MN
55345-1003
US

IV. Provider business mailing address

14126 GLENRIDGE RD
MINNETONKA MN
55345-4831
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-5600
  • Fax:
Mailing address:
  • Phone: 218-464-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1010397
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: