| Organization Name: | ADVANCE SPEECH THERAPY, LLC |
| NPI Number: | 1215144654 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER M JENSEN (OWNER) |
| Mailing Address: | 6776 Lake Dr 220 Lino Lakes |
| State: | MN US |
| Postal Code: | 550141191 |
| Phone Number: | 6517847007 |
| Fax Number: | 6517847992 |
| NPI Enumeration Date: | 05/16/2007 |
| NPI Last Update Date: | 01/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 8361 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |