Provider Demographics
NPI:1346741394
Name:EXPRESSIONS IN MOTION LLC
Entity Type:Organization
Organization Name:EXPRESSIONS IN MOTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SPEECH LANGUAGE PATHOLOGIS
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:ELY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC/SLP
Authorized Official - Phone:952-212-0385
Mailing Address - Street 1:2052 13TH AVE. W.
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379
Mailing Address - Country:US
Mailing Address - Phone:952-212-0385
Mailing Address - Fax:
Practice Address - Street 1:1221 EAST 4TH AVE.
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:952-212-0385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty