MEDICARE: PROF. FAITH CHRISTINE LOVEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	5445	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00899203	OTHER		AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
2	5445	OTHER	MN	DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1134491673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. FAITH CHRISTINE LOVEN PH.D.

Provider Business Mailing Address
First Line	:	31 W COLLEGE ST
Second Line	:	183 CHESTER PARK
City	:	DULUTH
State	:	MN
Zip	:	55812-1106
Country	:	US
Telephone Number	:	218-726-8204
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 W COLLEGE ST
Second Line	:	183 CHESTER PARK
City	:	DULUTH
State	:	MN
Zip	:	55812-1198
Country	:	US
Telephone Number	:	218-726-8204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	01/30/2012

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