Provider Demographics
NPI:1821168568
Name:AMDAHL HEARING LLC
Entity Type:Organization
Organization Name:AMDAHL HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:AMDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:320-252-0094
Mailing Address - Street 1:606 25TH AVE S
Mailing Address - Street 2:STE 107
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4800
Mailing Address - Country:US
Mailing Address - Phone:320-252-0094
Mailing Address - Fax:320-252-0365
Practice Address - Street 1:606 25TH AVE S
Practice Address - Street 2:STE 107
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4800
Practice Address - Country:US
Practice Address - Phone:320-252-0094
Practice Address - Fax:320-252-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7183237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty