Provider Demographics
NPI:1972624286
Name:AMDAHL, KEVIN (MA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:AMDAHL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 2ND STREET SOUTH
Mailing Address - Street 2:185
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4810
Mailing Address - Country:US
Mailing Address - Phone:320-252-0094
Mailing Address - Fax:320-252-0365
Practice Address - Street 1:2848 2ND ST S STE 185
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3708
Practice Address - Country:US
Practice Address - Phone:320-252-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI748-156231H00000X
MN6055237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter