Healthcare Provider Details

I. General information

NPI: 1659511004
Provider Name (Legal Business Name): PAMELA LYNN REYNOLDS-KLOCKE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA LYNN REYNOLDS AUD

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 RADIO DR
WOODBURY MN
55125-5805
US

IV. Provider business mailing address

215 RADIO DR STE 202
WOODBURY MN
55125-5822
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-0750
  • Fax: 651-645-6166
Mailing address:
  • Phone: 651-702-0750
  • Fax: 651-645-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberLICC-513
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLICC-513
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: