Provider Demographics
NPI:1265897714
Name:NELSON, ALICE L (HAD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
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:
Practice Address - Street 1:33 STATE RD
Practice Address - Street 2:SUITE B & C
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1304
Practice Address - Country:US
Practice Address - Phone:609-924-0534
Practice Address - Fax:609-924-8636
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ237600000X
NJ25MG00135200237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter