Basic Information
Provider Information | |||||||||
NPI: | 1700039575 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOPPENRATH | ||||||||
FirstName: | JACQUELINE | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.A. FAAA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6700 WASHINGTON AVE S | ||||||||
Address2: |   | ||||||||
City: | EDEN PRAIRIE | ||||||||
State: | MN | ||||||||
PostalCode: | 553443405 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6123511529 | ||||||||
FaxNumber: | 9522853980 | ||||||||
Practice Location | |||||||||
Address1: | 4570 CHURCHILL ST STE 130 | ||||||||
Address2: |   | ||||||||
City: | SHOREVIEW | ||||||||
State: | MN | ||||||||
PostalCode: | 55126 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6519677760 | ||||||||
FaxNumber: | 6512078644 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/24/2008 | ||||||||
LastUpdateDate: | 01/08/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 6166 | MN | N |   | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |   | 237700000X |   | MN | N |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   | 231H00000X |   | MN | Y |   | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.