Provider Demographics
NPI:1154779031
Name:PERLT, NICKOLAUS (HIS)
Entity type:Individual
Prefix:
First Name:NICKOLAUS
Middle Name:
Last Name:PERLT
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 DUNLAP ST N STE 115
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4203
Mailing Address - Country:US
Mailing Address - Phone:651-646-2427
Mailing Address - Fax:
Practice Address - Street 1:393 DUNLAP ST N STE 115
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4203
Practice Address - Country:US
Practice Address - Phone:651-646-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2786237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist