MEDICARE: HEARTLAND HEARING PROFESSIONALS PLLC

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	231HA2400X	Assistive Technology Practitioner Audiologist	989	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922542919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND HEARING PROFESSIONALS PLLC

Provider Business Mailing Address
First Line	:	3139 BLUE STEM DR STE 108
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8060
Country	:	US
Telephone Number	:	701-639-4595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3139 BLUE STEM DR STE 108
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8060
Country	:	US
Telephone Number	:	701-639-4595
Fax Number	:

Authorized Official
Title or Position	:	AUDIOLOGIST
Name	:	ROSE BRAKKE
Credential	:	AUD
Telephone Number	:	701-430-1017

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	12/28/2016

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Directions to “HEARTLAND HEARING PROFESSIONALS PLLC ” Practice Location

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