Healthcare Provider Details

I. General information

NPI: 1750463865
Provider Name (Legal Business Name): PROFESSIONAL HEARING & AUDIOLOGY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 32ND AVE N
SAINT CLOUD MN
56303-1649
US

IV. Provider business mailing address

1270 32ND AVE N
SAINT CLOUD MN
56303-1649
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-1978
  • Fax: 320-259-0362
Mailing address:
  • Phone: 320-259-1978
  • Fax: 320-259-0362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number5509
License Number StateMN

VIII. Authorized Official

Name: RICHARD K BROWN
Title or Position: AUDIOLOGIST/CEO
Credential: M.A., CCC-A
Phone: 320-259-1978