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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