Healthcare Provider Details

I. General information

NPI: 1649945569
Provider Name (Legal Business Name): AUDIOLOGY SPECIALTY CLINICS OF MINNESOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
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 215
EDINA MN
55435-4535
US

V. Phone/Fax

Practice location:
  • Phone: 952-224-0308
  • Fax: 952-831-4942
Mailing address:
  • Phone: 952-224-0308
  • Fax: 952-831-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: JASON LEYENDECKER
Title or Position: OWNER/AUDIOLOGIST
Credential: AUD
Phone: 952-224-0308