Basic Information
| Provider Information | |||||||||
| NPI: | 1316929458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUNYAN | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | REID | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003288602 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 N STATE OF FRANKLIN RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376043645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239289285 | ||||||||
| FaxNumber: | 4233280795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 2201001303 | VA | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | A0000001097 | TN | N | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237600000X | 2101001591 | VA | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.