1790934511 NPI number — MRS. JAN STORHAUG M. S., CCC-A

Table of content: MRS. JAN STORHAUG M. S., CCC-A (NPI 1790934511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790934511 NPI number — MRS. JAN STORHAUG M. S., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STORHAUG
Provider First Name:
JAN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M. S., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790934511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11210 WAYZATA BLVD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55305-2058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-746-3011
Provider Business Mailing Address Fax Number:
952-746-3012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11210 WAYZATA BLVD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55305-2058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-746-3011
Provider Business Practice Location Address Fax Number:
952-746-3012
Provider Enumeration Date:
09/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  7456 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7456 . This is a "STATE LICENSED AUDIOLOGIST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".