NPIMap

Organization Active NPI

Waseca Integrated Therapy Hub, LLC

  • Speech-Language Pathologist
  • Waseca, MN
National Provider Identifier
1851945919
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
WASECA INTEGRATED THERAPY HUB, LLC
Practice address
117 State St N
Waseca, MN 56093-2928
Phone
(507) 237-6336
NPI assigned
Jul 27, 2019
Last updated
Jun 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
Kenda Dougherty, MA, CCC-SLPNPI 1760681746
Title
Owner
Phone
(612) 986-2908

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 Primary

Addresses

Primary practice location

117 State St N
Waseca, MN 56093-2928

Mailing address

117 State St N
Waseca, MN 56093-2928
Phone (507) 237-6336

Other practice location 1

115 Landmark Dr NE Ste 1
Owatonna, MN 55060-5702
Phone (507) 237-6336

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200131001575 MN Part B Supplier - Clinic/Group Practice 4981030491 Receives reassigned benefits from 8 practitioners
Practice locations: Waseca, MN

National Provider Directory

National Provider Directory

Locations

110 2nd Ave SE
Ste B
Waseca, MN 56093
Phone (507) 237-6336

117 State St N
Waseca, MN 56093
Phone (507) 237-6336

Practitioners & affiliated clinicians

Practitioners 9

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": "1564185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1851945919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 STATE ST N",
            "city": "WASECA",
            "state": "MN",
            "postal_code": "560932928",
            "telephone_number": "507-237-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 STATE ST N",
            "city": "WASECA",
            "state": "MN",
            "postal_code": "560932928",
            "telephone_number": "507-237-6336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 Landmark Dr NE Ste 1",
            "address_purpose": "LOCATION",
            "city": "Owatonna",
            "state": "MN",
            "postal_code": "550605702",
            "country_code": "US",
            "telephone_number": "507-237-6336",
            "fax_number": "507-218-9736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WASECA INTEGRATED THERAPY HUB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-27",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "DOUGHERTY",
        "authorized_official_first_name": "KENDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-986-2908",
        "authorized_official_credential": "MA, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waseca, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.