Provider Demographics
NPI:1508961053
Name:STEP AHEAD PEDIATRIC REHAB INC.
Entity Type:Organization
Organization Name:STEP AHEAD PEDIATRIC REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SKOKAN
Authorized Official - Suffix:
Authorized Official - Credentials:MACCCSLP CEO
Authorized Official - Phone:651-554-9940
Mailing Address - Street 1:5695 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1619
Mailing Address - Country:US
Mailing Address - Phone:651-554-9940
Mailing Address - Fax:651-554-9941
Practice Address - Street 1:5695 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1619
Practice Address - Country:US
Practice Address - Phone:651-554-9940
Practice Address - Fax:651-554-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201297224Z00000X
MN103226225XP0200X
MN7330235Z00000X
MN7974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN89G72STLOtherSPEECH THERAPY GROUP CODE
MN89G71STOtherOCC THERAPY GROUP CODE
MN4600617OtherMEDICA