Provider Demographics
NPI:1114442613
Name:SIMONSON, TRAVIS (HIS)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:SIMONSON
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 NORRIS AVE SW
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-4137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 BROADWAY AVE S
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-1900
Practice Address - Country:US
Practice Address - Phone:320-559-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2797237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist