| NPI | 1376298489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZMINA VINING Speech Language Pathologist 651-353-0634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2022-02-16 |
| Last Update Date | 2022-02-16 |