Healthcare Provider Details

I. General information

NPI: 1306178603
Provider Name (Legal Business Name): STEPHEN C HUTT AU.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 VALLEY VIEW RD STE 301
EDINA MN
55424-1870
US

IV. Provider business mailing address

4420 VALLEY VIEW RD STE 301
EDINA MN
55424-1870
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-1793
  • Fax: 952-920-1799
Mailing address:
  • Phone: 952-920-1793
  • Fax: 952-920-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5462
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: