Healthcare Provider Details

I. General information

NPI: 1851556104
Provider Name (Legal Business Name): AFFILIATED AUDIOLOGY CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4638 E SHEA BLVD STE. B-170
PHOENIX AZ
85028-3072
US

IV. Provider business mailing address

4638 E SHEA BLVD STE. B-170
PHOENIX AZ
85028-3072
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-6041
  • Fax: 602-254-6735
Mailing address:
  • Phone: 602-254-6041
  • Fax: 602-254-6735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA719
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberDA719
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberDA719
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA719
License Number StateAZ

VIII. Authorized Official

Name: GEORGINE RAY
Title or Position: OWNER, PRESIDENT
Credential: AU.D.
Phone: 602-254-6041