Provider Demographics
NPI:1366178030
Name:LOUREY, SHANE J (HID)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:J
Last Name:LOUREY
Suffix:
Gender:M
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 2ND AVE SE STE 360
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-4155
Mailing Address - Country:US
Mailing Address - Phone:763-689-3226
Mailing Address - Fax:
Practice Address - Street 1:1820 2ND AVE SE STE 360
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-4155
Practice Address - Country:US
Practice Address - Phone:763-689-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2896237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNK571176690313OtherSTATE OF MN