Provider Demographics
NPI:1740950849
Name:PRAHL, DAVID A JR (CHID)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:PRAHL
Suffix:JR
Gender:M
Credentials:CHID
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:15966 QUAPAW ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-2223
Mailing Address - Country:US
Mailing Address - Phone:612-419-3149
Mailing Address - Fax:
Practice Address - Street 1:8990 SPRINGBROOK DR NW STE 255
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5880
Practice Address - Country:US
Practice Address - Phone:763-755-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2633237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2633OtherSTATE LICENSE