NPIMap

Organization Active NPI

Advance Therapy

  • Speech-Language Pathologist
  • Lino Lakes, MN
National Provider Identifier
1043644784
Registry record updated Aug 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
9165 Issued in MN
Legal business name
ADVANCE THERAPY
Practice address
6776 Lake Dr
Lino Lakes, MN 55014-1191
Phone
(651) 784-7007
NPI assigned
Aug 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer M JensenNPI 1386613412
Title
Speech-Language Pathologist
Phone
(651) 784-7007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 235Z00000X 9165 MN Primary

Addresses

Primary practice location

6776 Lake Dr
Lino Lakes, MN 55014-1191

Mailing address

3877 Big Timber TRL
Eagan, MN 55123-2474

National Provider Directory

National Provider Directory
Tax ID family
Advance Speech Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6776 Lake Dr
Lino Lakes, MN 55014
Phone (651) 498-2071

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377734400000",
    "number": "1043644784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3877 BIG TIMBER TRL",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551232474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6776 LAKE DR",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550141191",
            "telephone_number": "651-784-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-29",
        "last_updated": "2013-08-29",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "651-784-7007"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "9165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lino Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.