Provider Demographics
NPI:1205885118
Name:HOUGAS, WAYNE WILLIAM
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:WILLIAM
Last Name:HOUGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 OLD NORTH SHORE RD
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-4010
Mailing Address - Country:US
Mailing Address - Phone:218-834-4517
Mailing Address - Fax:
Practice Address - Street 1:920 E 1ST ST
Practice Address - Street 2:SUITE 301
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2201
Practice Address - Country:US
Practice Address - Phone:218-279-6279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5239231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN640000340Medicare PIN