Provider Demographics
NPI:1689935686
Name:KIM FISHMAN AUDIOLOGY
Entity Type:Organization
Organization Name:KIM FISHMAN AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-767-0672
Mailing Address - Street 1:11 10TH AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7505
Mailing Address - Country:US
Mailing Address - Phone:952-767-0672
Mailing Address - Fax:952-500-9955
Practice Address - Street 1:11 10TH AVE S STE A
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7505
Practice Address - Country:US
Practice Address - Phone:952-767-0672
Practice Address - Fax:952-500-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6400231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty