Provider Demographics
NPI:1386650216
Name:KNUDSEN, DANIEL E (AUD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:KNUDSEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:E
Other - Last Name:KNUDSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-0208
Mailing Address - Country:US
Mailing Address - Phone:970-817-2300
Mailing Address - Fax:970-817-2301
Practice Address - Street 1:3725 CLEVELAND AVE., UNIT I
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-0208
Practice Address - Country:US
Practice Address - Phone:970-817-2300
Practice Address - Fax:970-817-2301
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO643237600000X, 237600000X
IN23002456A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO643OtherCOLORADO AUDIOLOGY LICENSE NUMBER
AK42OtherALASKA AUDIOLOGY LICENSE NUMBER
IN23002456AOtherINDIANA AUDIOLOGY LICENSE NUMBER
CO643OtherCOLORADO AUDIOLOGY LICENSE NUMBER