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General NPI Number Information
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NPI Number | 1700328739
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Entity Type | Individual
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Provider Name | LORETTA JAEGER SLP
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Gender | Female
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 500 S CHERRY ST
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City | WACONIA
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State | MN
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Zip | 55387-4515
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Country | US
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Telephone | 952-856-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 10500 WAYZATA BLVD
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City | MINNETONKA
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State | MN
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Zip | 55305-1511
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Country | US
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Telephone | 952-224-1919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 5827
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License Number State | MN
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