Basic Information
Provider Information | |||||||||
NPI: | 1063994663 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOVATTER | ||||||||
FirstName: | KRISTIN | ||||||||
MiddleName: | RUSHELLE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | AU.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOVATTER | ||||||||
OtherFirstName: | KRISTIN | ||||||||
OtherMiddleName: | RUSHELLEE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | AU.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 6700 WASHINGTON AVE S | ||||||||
Address2: |   | ||||||||
City: | EDEN PRAIRIE | ||||||||
State: | MN | ||||||||
PostalCode: | 553443405 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6123511529 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 102 MATTHEW DR UNIT 102 | ||||||||
Address2: |   | ||||||||
City: | UNIONTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 154018418 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7244390210 | ||||||||
FaxNumber: | 7244390281 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/30/2018 | ||||||||
LastUpdateDate: | 01/18/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AT006610 | PA | N |   | Speech, Language and Hearing Service Providers | Audiologist |   | 231H00000X | A-0347 | WV | N |   | Speech, Language and Hearing Service Providers | Audiologist |   | 237700000X |   | PA | N |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   | 237600000X |   | PA | Y |   | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |   |
No ID Information.