Healthcare Provider Details

I. General information

NPI: 1457699563
Provider Name (Legal Business Name): ST LOUIS PARK SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 W 33RD ST
ST LOUIS PARK MN
55426-3403
US

IV. Provider business mailing address

6425 W 33RD ST
ST LOUIS PARK MN
55426-3403
US

V. Phone/Fax

Practice location:
  • Phone: 952-928-6000
  • Fax: 952-928-6020
Mailing address:
  • Phone: 952-928-6000
  • Fax: 952-928-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMI JO REYNOLDS
Title or Position: DIRECTOR OF SPECIAL SERVICES
Credential:
Phone: 952-928-6068