Provider Demographics
NPI:1770269417
Name:PEARSON, KENDAL HAYLEY (AUD)
Entity type:Individual
Prefix:
First Name:KENDAL
Middle Name:HAYLEY
Last Name:PEARSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 VIKINGS PKWY UNIT 404
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1956
Mailing Address - Country:US
Mailing Address - Phone:901-545-9430
Mailing Address - Fax:
Practice Address - Street 1:701 25TH AVE S BLDG FLOOR2
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1513
Practice Address - Country:US
Practice Address - Phone:612-365-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN528374231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist