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Organization
INTERACTIVE THERAPY SERVICES OF MINNESOTA INC
Active
Organization
INTERACTIVE THERAPY SERVICES OF MINNESOTA INC
Active
Other names
Functional Kids Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE ERNEST CCC-SLP (PRESIDENT/OWNER)
(651) 770-8884
Entity
Organization
Contact information
Practice address
14425 8TH AVE N, PLYMOUTH, MN 55447-4456
(651) 260-9915
Mailing address
14425 8TH AVE N, PLYMOUTH, MN 55447-4456
(651) 260-9915
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6402
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004292700
—
MN
01
—
181363
UCARE
MN
01
—
6HS76FU
BLUE CROSS BLUE SHIELD
MN
Enumeration date
02/18/2015
Last updated
09/02/2025
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