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General NPI Number Information
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NPI Number | 1043163926
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Entity Type | Organization
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Legal Business Name | RENEW PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 02/19/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 21995 FINLEY CT N
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City | FOREST LAKE
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State | MN
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Zip | 55025-9779
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Country | US
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Telephone | 480-529-0269
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Fax | 651-243-0305
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Provider Business Mailing Address
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Address Line | 21995 FINLEY CT N
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City | FOREST LAKE
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State | MN
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Zip | 55025-9779
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Country | US
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Telephone | 480-529-0269
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Fax | 651-243-0305
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Authorized Official
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Title or Position | OWNER
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Name | ELLEN E VAN TASSEL
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Credential | M.A., CCC-SLP
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Telephone | 480-529-0269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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