Provider Demographics
NPI:1639418759
Name:STOLTZ, KEVIN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:STOLTZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 DEERWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1887
Mailing Address - Country:US
Mailing Address - Phone:612-308-6761
Mailing Address - Fax:
Practice Address - Street 1:6001 EGAN DR
Practice Address - Street 2:SUITE 160
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4921
Practice Address - Country:US
Practice Address - Phone:612-564-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8355231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist