Healthcare Provider Details

I. General information

NPI: 1215212444
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N BEELINE HWY UNIT A
PAYSON AZ
85541-3780
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 928-478-8056
  • Fax: 503-659-5968
Mailing address:
  • Phone: 800-328-8602
  • Fax: 612-337-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

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