Provider Demographics
NPI:1750463865
Name:PROFESSIONAL HEARING & AUDIOLOGY SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING & AUDIOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:320-259-1978
Mailing Address - Street 1:1270 32ND AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1649
Mailing Address - Country:US
Mailing Address - Phone:320-259-1978
Mailing Address - Fax:320-259-0362
Practice Address - Street 1:1270 32ND AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1649
Practice Address - Country:US
Practice Address - Phone:320-259-1978
Practice Address - Fax:320-259-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5509237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty