Healthcare Provider Details

I. General information

NPI: 1710738737
Provider Name (Legal Business Name): KARRIE RECKER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MANITOBA ST
SPICER MN
56288-9629
US

IV. Provider business mailing address

133 LAKE AVE N
SPICER MN
56288-9616
US

V. Phone/Fax

Practice location:
  • Phone: 612-201-7306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number7392
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: