Provider Demographics
NPI:1124183314
Name:EAST CENTRAL AUDIOLOGY, LTD
Entity type:Organization
Organization Name:EAST CENTRAL AUDIOLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PERREAULT
Authorized Official - Suffix:
Authorized Official - Credentials:AUDIOLOGIST
Authorized Official - Phone:651-464-8486
Mailing Address - Street 1:1068 LAKE ST S
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2639
Mailing Address - Country:US
Mailing Address - Phone:651-464-8486
Mailing Address - Fax:651-464-8747
Practice Address - Street 1:1068 LAKE ST S
Practice Address - Street 2:SUITE 108
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2639
Practice Address - Country:US
Practice Address - Phone:651-464-8486
Practice Address - Fax:651-464-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6007231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114370OtherUCARE
MN41394OtherHEALTHPARTNERS
MN1011302OtherPERFERRED ONE
MN5G979EAOtherBLUE CROSS BLUE SHIELD
MN41394OtherHEALTHPARTNERS