Healthcare Provider Details

I. General information

NPI: 1104399005
Provider Name (Legal Business Name): BKT HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 TERREY PINE CT STE 110
EDEN PRAIRIE MN
55347-1107
US

IV. Provider business mailing address

7820 TERREY PINE CT STE 110
EDEN PRAIRIE MN
55347-1107
US

V. Phone/Fax

Practice location:
  • Phone: 952-594-8358
  • Fax: 952-479-4639
Mailing address:
  • Phone: 952-594-8358
  • Fax: 952-479-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH THOMAS
Title or Position: OWNER
Credential: AUDIOLOGIST
Phone: 952-594-8358