Healthcare Provider Details

I. General information

NPI: 1801687447
Provider Name (Legal Business Name): SARA JANSSEN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 SPRINGBROOK DR NW
COON RAPIDS MN
55433-5841
US

IV. Provider business mailing address

3992 WOODVIEW DR
VADNAIS HEIGHTS MN
55127-4115
US

V. Phone/Fax

Practice location:
  • Phone: 763-780-9155
  • Fax:
Mailing address:
  • Phone: 651-724-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number528788
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: