Provider Demographics
NPI:1003277203
Name:HEARING ON MAIN CORPORATION
Entity Type:Organization
Organization Name:HEARING ON MAIN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KJERSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:218-689-1854
Mailing Address - Street 1:335 CROCKER AVE N
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2316
Mailing Address - Country:US
Mailing Address - Phone:218-689-1854
Mailing Address - Fax:
Practice Address - Street 1:313 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-1905
Practice Address - Country:US
Practice Address - Phone:218-689-1854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8400237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty