Provider Demographics
NPI:1912133661
Name:SIMMONS, LARA RENEE (AUD)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:RENEE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:RENEE
Other - Last Name:VOLLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:5201 EDEN AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:952-929-2060
Mailing Address - Fax:952-929-2067
Practice Address - Street 1:5201 EDEN AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436
Practice Address - Country:US
Practice Address - Phone:952-929-2060
Practice Address - Fax:952-929-2067
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8487231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400197254Medicare PIN