Organization
RENEW PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN E VAN TASSEL M.A., CCC-SLP (OWNER)
(480) 529-0269
Entity
Organization
Contact information
Practice address
21995 FINLEY CT N, FOREST LAKE, MN 55025-9779
(480) 529-0269
(651) 243-0305
Mailing address
21995 FINLEY CT N, FOREST LAKE, MN 55025-9779
(480) 529-0269
(651) 243-0305
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
—
—
Other
Enumeration date
02/19/2026
Last updated
02/19/2026
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