Healthcare Provider Details

I. General information

NPI: 1821168568
Provider Name (Legal Business Name): AMDAHL HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 25TH AVE S STE 107
SAINT CLOUD MN
56301-4800
US

IV. Provider business mailing address

606 25TH AVE S STE 107
SAINT CLOUD MN
56301-4800
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-0094
  • Fax: 320-252-0365
Mailing address:
  • Phone: 320-252-0094
  • Fax: 320-252-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number7183
License Number StateMN

VIII. Authorized Official

Name: ERICA LYNN AMDAHL
Title or Position: PRESIDENT
Credential: MA
Phone: 320-252-0094