Provider Demographics
NPI:1689086167
Name:TC AUDIOLOGY LLC
Entity Type:Organization
Organization Name:TC AUDIOLOGY LLC
Other - Org Name:TC AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIESSE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:320-523-3435
Mailing Address - Street 1:611 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-4213
Mailing Address - Country:US
Mailing Address - Phone:320-523-1085
Mailing Address - Fax:
Practice Address - Street 1:600 E PARK AVE STE 2
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1370
Practice Address - Country:US
Practice Address - Phone:320-523-3435
Practice Address - Fax:320-323-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9024231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1619303682OtherNPI