Basic Information
| Provider Information | |||||||||
| NPI: | 1295237345 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHLAND HEARING CENTERS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
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| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1585 RANDOLPH AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551052149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513937999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2018 | ||||||||
| LastUpdateDate: | 03/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | WINCHESTER | ||||||||
| AuthorizedOfficialFirstName: | MELONY | ||||||||
| AuthorizedOfficialMiddleName: | RAE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 5036595115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.