Healthcare Provider Details

I. General information

NPI: 1386114759
Provider Name (Legal Business Name): FREEDOM AUDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 W ROOSEVELT ST STE 216
GOODYEAR AZ
85338-9342
US

IV. Provider business mailing address

15655 W ROOSEVELT ST STE 216
GOODYEAR AZ
85338-9342
US

V. Phone/Fax

Practice location:
  • Phone: 623-696-5817
  • Fax: 623-321-8009
Mailing address:
  • Phone: 623-696-5817
  • Fax: 623-321-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. COLLIN CORDERY
Title or Position: OWNER / AUDIOLOGIST
Credential: AU.D.
Phone: 623-696-5817