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General NPI Number Information
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NPI Number | 1497647580
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Entity Type | Individual
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Provider Name | JERRICA LANDE AU.D., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 1 VETERANS DR
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City | MINNEAPOLIS
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State | MN
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Zip | 55417-2309
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Country | US
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Telephone | 612-467-4082
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Fax |
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Provider Business Mailing Address
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Address Line | 7163 SUNSHINE DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55346-2755
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Country | US
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Telephone | 218-230-8083
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 9195
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License Number State | MN
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