Provider Demographics
NPI:1013330638
Name:DAVIS, JEFFREY K (HAD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:800-328-8602
Mailing Address - Fax:952-285-3980
Practice Address - Street 1:2531 S SHIELDS ST
Practice Address - Street 2:UNIT 2G
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1886
Practice Address - Country:US
Practice Address - Phone:970-484-8051
Practice Address - Fax:970-484-1087
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000899237700000X
COHAD.0000286237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist