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General NPI Number Information
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NPI Number | 1114442613
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Entity Type | Individual
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Provider Name | TRAVIS SIMONSON H.I.S.
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Gender | Male
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 221 BROADWAY AVE S
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City | COKATO
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State | MN
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Zip | 55321-1900
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Country | US
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Telephone | 320-559-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 760 NORRIS AVE SW
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City | COKATO
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State | MN
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Zip | 55321-4137
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2797
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License Number State | MN
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