| NPI | 1245983667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAILEY JO LEACH Speech Language Pathologist 952-215-2530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-01-27 |