Healthcare Provider Details

I. General information

NPI: 1033166699
Provider Name (Legal Business Name): AARON PENN M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

7151 158TH ST W
APPLE VALLEY MN
55124-5961
US

V. Phone/Fax

Practice location:
  • Phone: 651-467-4084
  • Fax:
Mailing address:
  • Phone: 952-431-7365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: