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General NPI Number Information
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NPI Number | 1386314151
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Entity Type | Organization
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Legal Business Name | ELEVATE SPEECH THERAPY LLC
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 13937 95TH AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-8933
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Country | US
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Telephone | 612-424-2701
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Fax |
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Provider Business Mailing Address
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Address Line | 13937 95TH AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-8933
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
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Name | KERRY LIPANOT
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Credential | CCC-SLP
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Telephone | 612-280-2923
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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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