Provider Demographics
NPI:1184687691
Name:GARLITZ, SHANNON JEAN (AUD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:JEAN
Last Name:GARLITZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:JEAN
Other - Last Name:KAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 JEFFERSON ROAD
Mailing Address - Street 2:ATTENTION AUDIOLOGY
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057
Mailing Address - Country:US
Mailing Address - Phone:507-663-9000
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:100 STATE AVE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6337
Practice Address - Country:US
Practice Address - Phone:507-334-3921
Practice Address - Fax:507-332-5297
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7299231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
640000160Medicare ID - Type Unspecified
P59648Medicare UPIN