MEDICARE: MRS. JENNIFER JEAN BORMANN M.S., CCC-A

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	6369	MN

General Provider Information

NPI Number	:	1629223722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER JEAN BORMANN M.S., CCC-A

Provider Business Mailing Address
First Line	:	8714 LYNDALE AVENUE SOUTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55420
Country	:	US
Telephone Number	:	952-948-9695
Fax Number	:	952-948-9086

Provider Business Practice Location Address
First Line	:	8714 LYNDALE AVENUE SOUTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55420
Country	:	US
Telephone Number	:	952-948-9695
Fax Number	:	952-948-9086

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

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/24/2008

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