Basic Information
| Provider Information | |||||||||
| NPI: | 1407093941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAU | ||||||||
| FirstName: | TODD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 GALLOWAY STREET | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158318966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4101 W DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563016600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202595841 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 02/09/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 2642 | MN | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.