Provider Demographics
NPI:1427594290
Name:AUDIOLOGY CONCEPTS GROUP
Entity Type:Organization
Organization Name:AUDIOLOGY CONCEPTS GROUP
Other - Org Name:AUDIOLOGY CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEYENDECKER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:952-831-4222
Mailing Address - Street 1:6446 XERXES AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1039
Mailing Address - Country:US
Mailing Address - Phone:952-831-4222
Mailing Address - Fax:
Practice Address - Street 1:6446 XERXES AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55423-1039
Practice Address - Country:US
Practice Address - Phone:952-831-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment