Provider Demographics
NPI:1992412936
Name:MIDWEST MYOFUNCTIONAL SERVICES LLC
Entity type:Organization
Organization Name:MIDWEST MYOFUNCTIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHOUNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-CLP, COM
Authorized Official - Phone:952-994-3913
Mailing Address - Street 1:11670 FOUNTAINS DR. N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11670 FOUNTAINS DR. N
Practice Address - Street 2:SUITE 200
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:952-994-9313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty