Healthcare Provider Details

I. General information

NPI: 1063471597
Provider Name (Legal Business Name): SALINE AUDIOLOGY ASSOCIATES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL PARK DR STE 101
BENTON AR
72015-3729
US

IV. Provider business mailing address

5 MEDICAL PARK DR STE 101
BENTON AR
72015-3729
US

V. Phone/Fax

Practice location:
  • Phone: 501-778-3868
  • Fax: 501-317-1704
Mailing address:
  • Phone: 501-778-3868
  • Fax: 501-317-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA#77
License Number StateAR

VIII. Authorized Official

Name: MRS. LISA C RICHEY
Title or Position: OWNER
Credential: AU.D.
Phone: 501-778-3868