Basic Information
| Provider Information | |||||||||
| NPI: | 1548433105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUST | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | |||||||||
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| Credential: | B.A.,B.S.,M.A.,AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 FERNBROOK LN N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554475321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635158222 | ||||||||
| FaxNumber: | 7635591424 | ||||||||
| Practice Location | |||||||||
| Address1: | 3812 COON RAPIDS BLVD NW | ||||||||
| Address2: | |||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554332517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635158226 | ||||||||
| FaxNumber: | 7635591424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2008 | ||||||||
| LastUpdateDate: | 04/03/2008 | ||||||||
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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 | 231H00000X | 8199 | MN | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.