=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477497154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXIS TERSCH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2026
-----------------------------------------------------
Last Update Date | 04/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 3RD ST NE
-----------------------------------------------------
City | RENVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56284-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-329-8368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 9TH AVE
-----------------------------------------------------
City | GRANITE FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56241-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-564-4081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1045198
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------