MEDICARE: STEP AHEAD PEDIATRIC REHAB INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	201297	MN
2	225XP0200X	Pediatric Occupational Therapist	103226	MN
3	235Z00000X	Speech-Language Pathologist	7330	MN
4	235Z00000X	Speech-Language Pathologist	7974	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89G72STL	OTHER	MN	SPEECH THERAPY GROUP CODE
2	89G71ST	OTHER	MN	OCC THERAPY GROUP CODE
3	4600617	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1508961053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEP AHEAD PEDIATRIC REHAB INC.

Provider Business Mailing Address
First Line	:	5695 BLAINE AVE
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1619
Country	:	US
Telephone Number	:	651-554-9940
Fax Number	:	651-554-9941

Provider Business Practice Location Address
First Line	:	5695 BLAINE AVE
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1619
Country	:	US
Telephone Number	:	651-554-9940
Fax Number	:	651-554-9941

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST OWNER
Name	:	MRS. JULIE RAE SKOKAN
Credential	:	MACCCSLP CEO
Telephone Number	:	651-554-9940

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	09/11/2025

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