Provider Demographics
NPI:1417148925
Name:OURADNIK, SHAUN GERARD
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:GERARD
Last Name:OURADNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3706
Mailing Address - Country:US
Mailing Address - Phone:888-333-9152
Mailing Address - Fax:763-268-4240
Practice Address - Street 1:6514 ODANA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1124
Practice Address - Country:US
Practice Address - Phone:608-829-3777
Practice Address - Fax:608-829-0430
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1280-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist