Provider Demographics
NPI:1023783537
Name:AXE AUDIOLOGY, LLC
Entity type:Organization
Organization Name:AXE AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YOUNK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:612-868-3461
Mailing Address - Street 1:393 DUNLAP ST N STE 115
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4203
Mailing Address - Country:US
Mailing Address - Phone:651-646-2427
Mailing Address - Fax:651-649-3018
Practice Address - Street 1:393 DUNLAP ST N STE 115
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4203
Practice Address - Country:US
Practice Address - Phone:651-646-2427
Practice Address - Fax:651-649-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7525OtherAUDIOLOGY LICENSE