Healthcare Provider Details

I. General information

NPI: 1700719390
Provider Name (Legal Business Name): ROSHNI MARIAN RAJA AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 NORTHWAY DR
SAINT CLOUD MN
56303-1287
US

IV. Provider business mailing address

1528 NORTHWAY DR
SAINT CLOUD MN
56303-1287
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-0233
  • Fax: 320-252-1421
Mailing address:
  • Phone: 320-252-0233
  • Fax: 320-252-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLICC-4417
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: