Organization
FUNDAMENTAL KIDS THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE M JOHNSON MA, CCC-SLP (OWNER)
(952) 297-2460
Entity
Organization
Contact information
Practice address
5985 RICE CREEK PKWY STE 205, SHOREVIEW, MN 55126-5037
(612) 888-4757
(612) 808-0005
Mailing address
5985 RICE CREEK PKWY STE 205, SHOREVIEW, MN 55126-5037
(612) 888-4757
(612) 808-0005
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
8614
MN
Other
Enumeration date
05/08/2013
Last updated
10/17/2021
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