Organization
INTERACTIVE THERAPY SERVICES, INC.
Active
Other names
Functional Kids
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE ERNEST (OWNER)
(651) 770-8884
Entity
Organization
Contact information
Practice address
2495 MAPLEWOOD DR STE 313, MAPLEWOOD, MN 55109-1913
(651) 770-8884
Mailing address
2495 MAPLEWOOD DR STE 313, MAPLEWOOD, MN 55109-1985
(651) 770-8884
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6402
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4600382
CBSA
MN
01
—
54M22IN
BLUE CROSS BLUE SHEILD
MN
01
—
75-732
HEALTH PARTNERS
MN
01
—
J033
U CARE
MN
Enumeration date
10/09/2006
Last updated
03/02/2016
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