Healthcare Provider Details

I. General information

NPI: 1174695308
Provider Name (Legal Business Name): LYNNE M HAWLEY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 FAIRVIEW BLVD SPECIALTY CLINIC
WYOMING MN
55092-8013
US

IV. Provider business mailing address

32443 OASIS RD
CENTER CITY MN
55012-9613
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-7651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5333
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number5333
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number5333
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number5333
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: