Healthcare Provider Details

I. General information

NPI: 1215064118
Provider Name (Legal Business Name): PORTABLE AUDIOMETRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 RIVER RIDGE RD
LITTLE ROCK AR
72227-1525
US

IV. Provider business mailing address

PO BOX 7697
LITTLE ROCK AR
72217-7697
US

V. Phone/Fax

Practice location:
  • Phone: 501-529-4094
  • Fax:
Mailing address:
  • Phone: 501-529-4094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number#236
License Number StateAR

VIII. Authorized Official

Name: MRS. LAURA BABETTE WARDLAW
Title or Position: PRESIDENT
Credential: MS. CCC-A
Phone: 501-529-4094