Healthcare Provider Details

I. General information

NPI: 1548460116
Provider Name (Legal Business Name): ANDREA LAMENDOLA THOMPSON AUD.,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PROVIDENCE PARK DR E BLDG. 2 SUITE 202
MOBILE AL
36695-4622
US

IV. Provider business mailing address

610 PROVIDENCE PARK DR E BLDG. 2 SUITE 202
MOBILE AL
36695-4622
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-2667
  • Fax: 251-633-2179
Mailing address:
  • Phone: 251-633-2667
  • Fax: 251-633-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAL 970-A
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAL 970-A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: