Organization
SOUTH METRO SPEECH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRISHA ROXANNE WITMER M.A., CCC-SLP (SPEECH & LANGUAGE PATHOLOGIST)
(612) 807-3723
Entity
Organization
Contact information
Practice address
327 MARSCHALL RD STE 390, SHAKOPEE, MN 55379-1700
(612) 807-3723
Mailing address
6490 OXFORD PL, SHAKOPEE, MN 55379-7063
(612) 807-3723
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
5928
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
513L2SO
BLUE CROSS BLUE SHIELD
MN
Enumeration date
03/19/2007
Last updated
08/22/2020
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