| Functional Kids Clinic | |
|
2495 Maplewood Dr Ste 313, Maplewood, MN 55109-1985 | |
| (651) 770-8884 | |
| (651) 770-8151 |
| Full Name | Functional Kids Clinic |
|---|---|
| Type | Facility |
| Speciality | Speech-language Pathologist |
| Location | 2495 Maplewood Dr Ste 313, Maplewood, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083005664 | NPI | - | NPPES |
| 6HS76FU | Other | MN | BLUE CROSS BLUE SHIELD |
| 004292700 | Medicaid | MN | |
| 181363 | Other | MN | UCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 235Z00000X | Speech-language Pathologist | 6402 (Minnesota) | Primary |
| Provider Name | Julie K Ernest |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1821187485 PECOS PAC ID: 3678741659 Enrollment ID: I20110718000619 |
| Provider Name | Kelly A Riordan-jaeschke |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1164648028 PECOS PAC ID: 3476855313 Enrollment ID: I20160108000952 |
| Provider Name | Melanie C Sanmiguel |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1740423177 PECOS PAC ID: 9234432121 Enrollment ID: I20160127001252 |
| Provider Name | Abigail K Trebelhorn |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1851979579 PECOS PAC ID: 0042611121 Enrollment ID: I20210628000146 |
| Mailing Address | Practice Location Address |
|---|---|
| Functional Kids Clinic 2495 Maplewood Dr Ste 313, Maplewood, MN 55109-1985 Ph: (651) 770-8884 | Functional Kids Clinic 2495 Maplewood Dr Ste 313, Maplewood, MN 55109-1985 Ph: (651) 770-8884 |
Erin Topitzhofer, M.A. CCC-SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 2945 Hazelwood St, Maplewood, MN 55109 Phone: 651-232-7800 | |
Samantha Buerger, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 1900 Sherren Ave E, Maplewood, MN 55109 Phone: 651-770-1365 | |
Anna Udenberg, Speech-Language Pathologist Medicare: Medicare Enrolled Practice Location: 2495 Maplewood Dr Ste 313, Maplewood, MN 55109 Phone: 651-770-8884 | |
Laura Gunderson, M.S. CCC-SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 2395 Ariel St N, Maplewood, MN 55109 Phone: 651-773-3208 | |
Julie Swedburg, MS, CCC-SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 2495 Maplewood Dr Ste 313, Maplewood, MN 55109 Phone: 651-770-8884 Fax: 651-770-8151 | |
Functional Kids Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 2495 Maplewood Dr Ste 313, Maplewood, MN 55109 Phone: 651-770-8884 |