Provider Demographics
NPI:1225374606
Name:RUDD, KATHRYN ALEXIS (AUD)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ALEXIS
Last Name:RUDD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVENUE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:718-577-5820
Practice Address - Street 1:1021 BANDANA BLVD
Practice Address - Street 2:STE 100
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5109
Practice Address - Country:US
Practice Address - Phone:651-241-9700
Practice Address - Fax:718-577-5820
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002442237600000X
MN8723231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter