Provider Demographics
NPI:1467498725
Name:STRAND, BLAKE GORDON (AU D CC A)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:GORDON
Last Name:STRAND
Suffix:
Gender:M
Credentials:AU D CC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 WOODWINDS DR
Mailing Address - Street 2:#240
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2523
Mailing Address - Country:US
Mailing Address - Phone:651-702-0750
Mailing Address - Fax:
Practice Address - Street 1:2080 WOODWINDS DR
Practice Address - Street 2:#240
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2523
Practice Address - Country:US
Practice Address - Phone:651-702-0750
Practice Address - Fax:651-702-0749
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5567231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
040000057Medicare ID - Type Unspecified