| NPI | 1093217812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER PEDREGUERA Credentialing Specialist 952-947-4602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0700X Clinic/Center, Hearing and Speech |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2019-05-31 |