Healthcare Provider Details

I. General information

NPI: 1801095955
Provider Name (Legal Business Name): CHILDREN'S THERAPY SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LEWIS AVE S SUITE 104
WATERTOWN MN
55388-4500
US

IV. Provider business mailing address

204 LEWIS AVE S SUITE 104
WATERTOWN MN
55388-4500
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-3323
  • Fax: 952-255-8075
Mailing address:
  • Phone: 952-955-3323
  • Fax: 952-255-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7578
License Number StateMN

VIII. Authorized Official

Name: MRS. TONYA KAY SCHRADER
Title or Position: PRESIDENT
Credential: M.S. CCC-SLP
Phone: 952-955-3323