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General NPI Number Information
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NPI Number | 1194606632
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Entity Type | Organization
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Legal Business Name | GROWTHPATH LLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 515 15TH AVE S UNIT 222
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1428
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Country | US
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Telephone | 651-440-5588
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Fax |
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Provider Business Mailing Address
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Address Line | 515 15TH AVE S UNIT 222
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1428
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Country | US
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Telephone | 651-440-5588
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | KHADAR FARAH
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Credential |
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Telephone | 651-440-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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