Healthcare Provider Details

I. General information

NPI: 1154674505
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 HWAY 95 STE 102
BULLHEAD CITY AZ
86442-8219
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 720-614-7243
  • Fax: 720-614-7253
Mailing address:
  • Phone: 800-328-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberBHAD8063
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberBHAD8063
License Number StateAZ

VIII. Authorized Official

Name: REGINA KRISTINE TOENSING
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 952-915-6255