Basic Information
| Provider Information | |||||||||
| NPI: | 1184687691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARLITZ | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | AU.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KAHL | ||||||||
| OtherFirstName: | SHANNON | ||||||||
| OtherMiddleName: | JEAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1400 JEFFERSON ROAD | ||||||||
| Address2: | ATTENTION AUDIOLOGY | ||||||||
| City: | NORTHFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076639000 | ||||||||
| FaxNumber: | 6122624194 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 STATE AVE | ||||||||
| Address2: | |||||||||
| City: | FARIBAULT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550216337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073343921 | ||||||||
| FaxNumber: | 5073325297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 7299 | MN | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.