NPIMap

Organization Active NPI

TLC

  • Speech-Language Pathologist
  • Inver Grove Heights, MN
National Provider Identifier
1336404821
Registry record updated Jul 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
5742 Issued in MN
Legal business name
TLC
Practice address
5641 Audrey Ave
Inver Grove Heights, MN 55077-1812
Phone
(612) 554-5005
NPI assigned
Jul 10, 2012
Last updated
Jul 10, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
THE LYMPHEDEMA CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2012

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

Authorized official

Name
Colleen Martens Endrizzi
Title
Ceo
Phone
(612) 554-5005

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 101152 MN
Speech-Language Pathologist 235Z00000X 5742 MN Primary

Addresses

Primary practice location

5641 Audrey Ave
Inver Grove Heights, MN 55077-1812

Mailing address

6311 Wayzata Blvd
Suite 310
Minneapolis, MN 55416-1209
Phone (952) 545-0200

National Provider Directory

National Provider Directory
Tax ID family
Colleen Martens Endrizzi in4 organizations share this tax ID, including this one
Part of
Colleen Martens Endrizzi in

Other organizations with this tax ID 3

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

Locations

6311 Wayzata Blvd
Ste 310
Minneapolis, MN 55416

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341878400000",
    "number": "1336404821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6311 WAYZATA BLVD",
            "address_2": "SUITE 310",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554161209",
            "telephone_number": "952-545-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5641 AUDREY AVE",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550771812",
            "telephone_number": "612-554-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE LYMPHEDEMA CENTER",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-07-10",
        "status": "A",
        "authorized_official_last_name": "MARTENS ENDRIZZI",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-554-5005"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "101152",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "5742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Inver Grove Heights, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; 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.