Basic Information
| Provider Information | |||||||||
| NPI: | 1609227321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLINE | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | HA60662051 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123511529 | ||||||||
| FaxNumber: | 9522853980 | ||||||||
| Practice Location | |||||||||
| Address1: | 1102 OUTLET COLLECTION WAY SW STE 102 | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533519300 | ||||||||
| FaxNumber: | 2533519302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2016 | ||||||||
| LastUpdateDate: | 09/05/2018 | ||||||||
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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 | 237600000X | HA60662051 | WA | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | HA60662051 | WA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.