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General NPI Number Information
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NPI Number | 1104043587
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Entity Type | Organization
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Legal Business Name | NORTHSTAR CIRCLE OF COMPANIES, INC.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 2381 CARTER AVE
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City | SAINT PAUL
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State | MN
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Zip | 55108-1625
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Country | US
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Telephone | 651-646-0471
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Fax | 651-646-0470
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Provider Business Mailing Address
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Address Line | PO BOX 8116
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City | SAINT PAUL
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State | MN
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Zip | 55108-0116
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST OWNER
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Name | DR. SUSAN WEBER
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Credential | PH.D.
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Telephone | 651-646-0471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 5331
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License Number State | MN
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