Healthcare Provider Details

I. General information

NPI: 1033234687
Provider Name (Legal Business Name): AUBURN UNIVERSITY MONTGOMERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7041 SENATORS DR LIBERAL ARTS BUILDING ROOM 110
MONTGOMERY AL
36117
US

IV. Provider business mailing address

PO BOX 244023
MONTGOMERY AL
36124-4023
US

V. Phone/Fax

Practice location:
  • Phone: 334-244-3408
  • Fax: 334-244-3906
Mailing address:
  • Phone: 334-244-3408
  • Fax: 334-244-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS E BORTON
Title or Position: PROFESSOR DIRECTOR
Credential: PHD FAAA CCC-A
Phone: 334-244-3408