Basic Information
| Provider Information | |||||||||
| NPI: | 1477627826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEISS | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MS CCCA | ||||||||
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| OtherLastName: | WEISS | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2910 CENTRE POINTE DRIVE | ||||||||
| Address2: | CHILDRENS HEALTH CARE | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518552109 | ||||||||
| FaxNumber: | 6518552310 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 CHICAGO AVENUE SOUTH | ||||||||
| Address2: | CHILDRENS HOSPITALS AND CLINICS AUDIOLOGY MPLS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128136709 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 7030 | MN | X | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 7030 | MN | X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | 7030 | MN | X | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.