Healthcare Provider Details

I. General information

NPI: 1972774461
Provider Name (Legal Business Name): MARY CRITCHLEY AUDIOLOGIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S EUCLID ST SUITE 6
ANAHEIM CA
92802-1530
US

IV. Provider business mailing address

720 S EUCLID ST SUITE 6
ANAHEIM CA
92802-1530
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-8757
  • Fax: 714-776-8758
Mailing address:
  • Phone: 714-776-8757
  • Fax: 714-776-8758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU1754
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHA3751
License Number StateCA

VIII. Authorized Official

Name: MS. MARY CRITCHLEY
Title or Position: PRESIDENT
Credential: M.A.
Phone: 714-776-8757