NPIMap

Organization Active NPI

Lakeshore Pediatric Therapy, Inc.

  • Speech-Language Pathologist
  • Minnetonka, MN
National Provider Identifier
1588090179
Registry record updated Sep 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
8141 Issued in MN
Legal business name
LAKESHORE PEDIATRIC THERAPY, INC.
Practice address
13304 Loveland Cir
Minnetonka, MN 55305-2306
Phone
(612) 202-5132
NPI assigned
Sep 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2013

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

Authorized official

Name
Ms. Karen Diaz, M.S. CCC-SLPNPI 1225179955
Title
Director
Phone
(612) 202-5132

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 8141 MN Primary

Addresses

Primary practice location

13304 Loveland Cir
Minnetonka, MN 55305-2306

Mailing address

13304 Loveland Cir
Minnetonka, MN 55305-2306
Phone (612) 202-5132

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1379289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379289600000",
    "number": "1588090179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13304 LOVELAND CIR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553052306",
            "telephone_number": "612-202-5132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13304 LOVELAND CIR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553052306",
            "telephone_number": "612-202-5132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE PEDIATRIC THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-16",
        "last_updated": "2013-09-16",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "612-202-5132",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.S. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "8141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.