| |
1104 7th Ave South, Msum Box 119, Moorhead, MN 56563-0001 | |
(218) 477-2330 | |
(218) 477-2330 |
Full Name | |
---|---|
Type | Facility |
Speciality | Audiologist |
Location | 1104 7th Ave South, Moorhead, Minnesota |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1558421404 | NPI | - | NPPES |
52B45MO | Other | MN | MN BCBS |
51661 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
231H00000X | Audiologist | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
1104 7th Ave South, Msum Box 119, Moorhead, MN 56563-0001 Ph: (218) 477-2330 | 1104 7th Ave South, Msum Box 119, Moorhead, MN 56563-0001 Ph: (218) 477-2330 |
Mary Kathleen Drake, AUD CCCA Audiologist Medicare: Medicare Enrolled Practice Location: 1104 7th Ave South, Msum Box 119, Moorhead, MN 56563 Phone: 218-477-5953 Fax: 518-477-4392 |