Provider Demographics
NPI:1548433105
Name:AUST, JAY (BA,BS,MA,AUD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:AUST
Suffix:
Gender:M
Credentials:BA,BS,MA,AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 FERNBROOK LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5321
Mailing Address - Country:US
Mailing Address - Phone:763-515-8222
Mailing Address - Fax:763-559-1424
Practice Address - Street 1:3812 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2517
Practice Address - Country:US
Practice Address - Phone:763-515-8226
Practice Address - Fax:763-559-1424
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8199231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist