MEDICARE: MS. JUNE MARIE RYDBERG MS CCC SLP

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	235Z00000X	Speech-Language Pathologist	563-154	WI
2	235Z00000X	Speech-Language Pathologist	9139	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	563	OTHER	WI	WISCONSIN LICENSE

General Provider Information

NPI Number	:	1821163213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUNE MARIE RYDBERG MS CCC SLP

Provider Business Mailing Address
First Line	:	8170 33RD AVE S
Second Line	:	MS 21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:	651-254-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 PHALEN BLVD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55485
Country	:	US
Telephone Number	:	651-254-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	03/18/2021

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