| Jka5 Hudson Inc | |
|
411 Stageline Rd # 290, Hudson, WI 54016-7848 | |
| (715) 531-6710 | |
| Not Available |
| Full Name | Jka5 Hudson Inc |
|---|---|
| Type | Facility |
| Speciality | Audiologist |
| Location | 411 Stageline Rd # 290, Hudson, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417484239 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 231H00000X | Audiologist | (* (Not Available)) | Primary |
| Provider Name | Raena S Deperry |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1114018447 PECOS PAC ID: 5092896233 Enrollment ID: I20080114000841 |
| Provider Name | Kevin David Amdahl |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1972624286 PECOS PAC ID: 8123123890 Enrollment ID: I20211103000718 |
| Provider Name | Daniel Joseph Dibenedetto |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1326778416 PECOS PAC ID: 3870973027 Enrollment ID: I20220705003020 |
| Provider Name | Ryan William Schwantes |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1720874928 PECOS PAC ID: 2860911047 Enrollment ID: I20250521002769 |
| Mailing Address | Practice Location Address |
|---|---|
| Jka5 Hudson Inc 2848 2nd St S, Suite 185, Saint Cloud, MN 56301-4594 Ph: (320) 252-0094 | Jka5 Hudson Inc 411 Stageline Rd # 290, Hudson, WI 54016-7848 Ph: (715) 531-6710 |
Dr. Raena Sue Deperry, AUD Audiologist Medicare: Accepting Medicare Assignments Practice Location: 401 Stageline Rd, Ste. 6, Hudson, WI 54016 Phone: 715-531-6710 Fax: 715-531-6711 | |
Mrs. Deirdre Ann Worrell, MS Audiologist Medicare: Not Enrolled in Medicare Practice Location: 1516 North Ridge Dr, Hudson, WI 54016 Phone: 715-386-1760 | |
Elizabeth K Brown, AU.D Audiologist Medicare: Not Enrolled in Medicare Practice Location: 411 Stageline Rd Ste 290, Hudson, WI 54016 Phone: 715-500-4733 | |
Mrs. Michele Anne Drevnick, M.S., F-AAA Audiologist Medicare: Not Enrolled in Medicare Practice Location: 401 Stageline Rd, Suite 6, Hudson, WI 54016 Phone: 715-531-6710 Fax: 715-531-6711 | |
Ryan William Schwantes, AUD Audiologist Medicare: Medicare Enrolled Practice Location: 411 Stageline Rd, Hudson, WI 54016 Phone: 913-563-5478 Fax: 913-701-3317 |