Provider Demographics
NPI:1124162706
Name:ANDERSON, BLANE AUSEN (CCC-A)
Entity type:Individual
Prefix:MR
First Name:BLANE
Middle Name:AUSEN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:825 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1203
Practice Address - Country:US
Practice Address - Phone:507-359-1932
Practice Address - Fax:507-354-1369
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5919237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter