Healthcare Provider Details

I. General information

NPI: 1639336407
Provider Name (Legal Business Name): HEARING HELP AUDIOLOGY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 INDUSTRIAL PARK BLVD #105
PLYMOUTH MN
55441-3974
US

IV. Provider business mailing address

12800 INDUSTRIAL PARK BLVD #105
PLYMOUTH MN
55441-3974
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-0603
  • Fax: 763-559-0985
Mailing address:
  • Phone: 763-559-0603
  • Fax: 763-559-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number231H00000X
License Number StateMN

VIII. Authorized Official

Name: DR. SHIRLEY ANN FORS
Title or Position: AUDIOLOGIST
Credential: AU.D.
Phone: 763-559-0603