Provider Demographics
NPI:1710021290
Name:KNUDSEN, INC.
Entity Type:Organization
Organization Name:KNUDSEN, INC.
Other - Org Name:INDEPENDENT AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KNUDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:970-817-1965
Mailing Address - Street 1:1020 WABASH ST
Mailing Address - Street 2:UNIT 5-104
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-3191
Mailing Address - Country:US
Mailing Address - Phone:970-817-1965
Mailing Address - Fax:
Practice Address - Street 1:1014 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1849
Practice Address - Country:US
Practice Address - Phone:970-817-1965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNO. 42237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO643OtherCOLORADO AUDIOLOGY LICENSE
IN23002456AOtherINDIANA AUDIOLOGY LICENSE
AK42OtherALASKA AUDIOLOGY LICENSE