Healthcare Provider Details

I. General information

NPI: 1356159628
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712C E IRLO BRONSON MEMORIAL HWY STE C
ST CLOUD FL
34771
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 407-910-4700
  • Fax:
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 State

VIII. Authorized Official

Name: LORI MONSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 952-941-6401