Healthcare Provider Details

I. General information

NPI: 1710413547
Provider Name (Legal Business Name): AUDIOLOGY CONCEPTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 FRANCE AVE S STE 200
EDINA MN
55435-4506
US

IV. Provider business mailing address

7380 FRANCE AVE S STE 200
EDINA MN
55435-4506
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-4222
  • Fax: 952-831-4942
Mailing address:
  • Phone: 952-831-4222
  • Fax: 952-831-4942

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: JASON LEYENDECKER
Title or Position: OWNER
Credential: AUD
Phone: 952-831-4222