Active NPI
Kathleen Jacklen, CCC/AUD
- Audiologist
- Virginia, MN
National Provider Identifier
1497989941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 5683
- Practice address
- 1101 9TH St N
Virginia, MN 55792-2329 - Phone
- (218) 741-0150
- NPI assigned
- May 13, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 5683 | MN | Primary |
Addresses
Primary practice location
1101 9TH St N
Virginia, MN 55792-2329
Mailing address
1101 9TH St N
Virginia, MN 55792-2329
Phone (218) 741-0150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5683 | MN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242172800000",
"number": "1497989941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 9TH ST N",
"city": "VIRGINIA",
"state": "MN",
"postal_code": "557922329",
"telephone_number": "218-741-0150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 9TH ST N",
"city": "VIRGINIA",
"state": "MN",
"postal_code": "557922329",
"telephone_number": "218-741-0150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKLEN",
"first_name": "KATHLEEN",
"credential": "CCC/AUD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-13",
"last_updated": "2009-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MN",
"license": "5683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.