Healthcare Provider Details

I. General information

NPI: 1194402115
Provider Name (Legal Business Name): IVY VY HO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9097 E DESERT COVE AVE STE 250
SCOTTSDALE AZ
85260-6278
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 250
SCOTTSDALE AZ
85260-6278
US

V. Phone/Fax

Practice location:
  • Phone: 480-273-8688
  • Fax:
Mailing address:
  • Phone: 480-273-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA14527
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: