Provider Demographics
NPI:1447403175
Name:KMETT, LOREN DALE (AUDIOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:DALE
Last Name:KMETT
Suffix:
Gender:M
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3331
Mailing Address - Country:US
Mailing Address - Phone:218-829-2162
Mailing Address - Fax:218-828-5013
Practice Address - Street 1:215 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3331
Practice Address - Country:US
Practice Address - Phone:218-829-2162
Practice Address - Fax:218-828-5013
Is Sole Proprietor?:No
Enumeration Date:2008-10-26
Last Update Date:2008-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7307231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN161081OtherUCARE
MN96G70KMOtherBLUE CROSS BLUE SHIELD
MN266652900Medicaid