Individual provider Active NPI

Marijana Ekvall

  • Speech-Language Pathologist
  • Stillwater, MN
National Provider Identifier
1487402046
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
6555 Issued in WI
Practice address
927 Churchill St W
Stillwater, MN 55082-6605
Phone
(651) 439-5330
NPI assigned
May 8, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 6555 WI Primary

Addresses

Primary practice location

927 Churchill St W
Stillwater, MN 55082-6605

Mailing address

202 Hamilton Dr
River Falls, WI 54022-3104
Phone (608) 807-8384

Other practice location 1

265 Griffin St E
Amery, WI 54001-1439
Phone (715) 268-8000

Other practice location 2

411 Stageline Rd
Hudson, WI 54016-7848
Phone (715) 531-6700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240529002260 MN Practitioner - Qualified Speech Language Pathologist 3577905017 Reassigns benefits to 1 organization
I20240529002542 WI Practitioner - Qualified Speech Language Pathologist 3577905017 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians

Practice addresses (Care Compare)

1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Phone (952) 831-8742

403 Stageline Rd
Hudson, WI 54016-7848
Phone (952) 831-8742

405 Stageline Rd
Hudson, WI 54016-7848
Phone (952) 831-8742

411 Stageline Rd
Hudson, WI 54016-7848
Phone (952) 831-8742

8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6555WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tria Orthopaedic Center LLC CurrentSince Jan 1, 2025 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Jun 17, 2024 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Jun 17, 2024 Accepting new patients
Group Health, Inc. Past Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

927 Churchill St W
Stillwater, MN 55082
Phone (651) 430-4529

1500 Curve Crest Blvd W
Stillwater, MN 55082

265 Griffin St E
Amery, WI 54001
Phone (715) 268-0301

405 Stageline Rd
Hudson, WI 54016
Phone (715) 531-6000

411 Stageline Rd
Hudson, WI 54016
Phone (715) 531-6000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1715126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1487402046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 HAMILTON DR",
            "city": "RIVER FALLS",
            "state": "WI",
            "postal_code": "540223104",
            "telephone_number": "608-807-8384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 CHURCHILL ST W",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826605",
            "telephone_number": "651-439-5330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "265 Griffin St E",
            "address_purpose": "LOCATION",
            "city": "Amery",
            "state": "WI",
            "postal_code": "540011439",
            "country_code": "US",
            "telephone_number": "715-268-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "411 Stageline Rd",
            "address_purpose": "LOCATION",
            "city": "Hudson",
            "state": "WI",
            "postal_code": "540167848",
            "country_code": "US",
            "telephone_number": "715-531-6700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EKVALL",
        "first_name": "MARIJANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-08",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "6555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.