MEDICARE: ALASKA SPEECH & HEARING CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	AU7673	AK
2	235Z00000X	Speech-Language Pathologist	SP7673	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982884235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALASKA SPEECH & HEARING CLINIC LLC

Provider Business Mailing Address
First Line	:	2401 E 42ND AVE
Second Line	:	#101
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5391
Country	:	US
Telephone Number	:	907-562-4550
Fax Number	:	907-562-4554

Provider Business Practice Location Address
First Line	:	2401 E 42ND AVE
Second Line	:	#101
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5391
Country	:	US
Telephone Number	:	907-562-4550
Fax Number	:	907-562-4554

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. LISA M OWENS
Credential	:	AUD
Telephone Number	:	907-562-4550

Provider Enumeration Date	:	11/04/2007
Last Update Date	:	06/26/2008

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