Provider Demographics
NPI:1558564989
Name:COLLINS, KENT J (AUD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
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Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:612-351-1529
Mailing Address - Fax:952-914-7931
Practice Address - Street 1:24310 MOULTON PKWY STE D
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3306
Practice Address - Country:US
Practice Address - Phone:949-830-5330
Practice Address - Fax:949-830-6926
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN231H00000X, 237700000X
231HA2400X
AZDA5789237600000X
MN7479237600000X
NVA206237600000X
NM4286237600000X
CAAU2994231H00000X
NV305 DISPENSING237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN640000586OtherMEDICARE
MN927630000Medicaid
NVCT168ZMedicare PIN