=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770269417
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDAL HAYLEY PEARSON AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2023
-----------------------------------------------------
Last Update Date | 06/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 25TH AVE S BLDG FLOOR2
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55454-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-365-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 VIKINGS PKWY UNIT 404
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55121-1956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-545-9430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 528374
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------