Provider Demographics
NPI:1649945569
Name:AUDIOLOGY SPECIALTY CLINICS OF MINNESOTA
Entity type:Organization
Organization Name:AUDIOLOGY SPECIALTY CLINICS OF MINNESOTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYENDECKER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:952-224-0308
Mailing Address - Street 1:7380 FRANCE AVE S STE 215
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4535
Mailing Address - Country:US
Mailing Address - Phone:952-224-0308
Mailing Address - Fax:952-831-4942
Practice Address - Street 1:7380 FRANCE AVE S STE 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4506
Practice Address - Country:US
Practice Address - Phone:952-224-0308
Practice Address - Fax:952-831-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty