Organization
ADVANCE SPEECH THERAPY, LLC
Active
Other names
Advance Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER M JENSEN CCC-SLP (OWNER)
(651) 784-7007
Entity
Organization
Contact information
Practice address
6776 LAKE DR, 220, LINO LAKES, MN 55014
(651) 784-7007
(651) 784-7992
Mailing address
6776 LAKE DR, 220, LINO LAKES, MN 55014-1191
(651) 784-7007
(651) 784-7992
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7350
MN
235Z00000X
Speech-Language Pathologist
8361
MN
235Z00000X
Speech-Language Pathologist
8490
MN
235Z00000X
Speech-Language Pathologist
8679
MN
235Z00000X
Speech-Language Pathologist
8826
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073222200
—
MN
Enumeration date
05/16/2007
Last updated
07/02/2018
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