Basic Information
| Provider Information | |||||||||
| NPI: | 1558564989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | KENT | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123511529 | ||||||||
| FaxNumber: | 9529147931 | ||||||||
| Practice Location | |||||||||
| Address1: | 24310 MOULTON PKWY STE D | ||||||||
| Address2: | |||||||||
| City: | LAGUNA WOODS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926373306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498305330 | ||||||||
| FaxNumber: | 9498306926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | MN | N | Speech, Language and Hearing Service Providers | Audiologist | 231HA2400X | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 237600000X | A206 | NV | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237600000X | 4286 | NM | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237600000X | DA5789 | AZ | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237600000X | 7479 | MN | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | MN | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 305 DISPENSING | NV | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | AU2994 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 640000586 | 01 | MN | MEDICARE | OTHER | 927630000 | 05 | MN | MEDICAID |