Provider Demographics
NPI:1942592928
Name:SPIRIT RIVER AUDIOLOGY LLC
Entity Type:Organization
Organization Name:SPIRIT RIVER AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:HELMBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:763-300-3019
Mailing Address - Street 1:15201 QUICKSILVER ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5694
Mailing Address - Country:US
Mailing Address - Phone:763-300-3019
Mailing Address - Fax:
Practice Address - Street 1:237 2ND AVE SW
Practice Address - Street 2:#230
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1536
Practice Address - Country:US
Practice Address - Phone:763-300-3019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6425231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty