Provider Demographics
NPI:1568869188
Name:JKA5 ENTERPRISES
Entity Type:Organization
Organization Name:JKA5 ENTERPRISES
Other - Org Name:AMDAHL HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-964-4395
Mailing Address - Street 1:2848 2ND ST S
Mailing Address - Street 2:185
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4594
Mailing Address - Country:US
Mailing Address - Phone:320-252-0094
Mailing Address - Fax:
Practice Address - Street 1:2848 2ND ST S
Practice Address - Street 2:185
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4594
Practice Address - Country:US
Practice Address - Phone:320-252-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty