MEDICARE: MR. JACOB MICHAEL ENDER

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	14476841	MN

General Provider Information

NPI Number	:	1821926155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB MICHAEL ENDER

Provider Business Mailing Address
First Line	:	11400 MAGNOLIA ST NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-3227
Country	:	US
Telephone Number	:	763-433-4933
Fax Number	:

Provider Business Practice Location Address
First Line	:	11400 MAGNOLIA ST NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-3227
Country	:	US
Telephone Number	:	763-433-4933
Fax Number	:

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

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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Directions to “ MR. JACOB MICHAEL ENDER ” Practice Location

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