Healthcare Provider Details

I. General information

NPI: 1104316587
Provider Name (Legal Business Name): ELK GROVE HEARING CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 W STOCKTON BLVD STE 103
ELK GROVE CA
95758-8070
US

IV. Provider business mailing address

9300 W STOCKTON BLVD STE 103
ELK GROVE CA
95758-8070
US

V. Phone/Fax

Practice location:
  • Phone: 916-627-1494
  • Fax:
Mailing address:
  • Phone: 916-627-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU2591
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7877
License Number StateCA

VIII. Authorized Official

Name: DR. AMY WHITE
Title or Position: AUDIOLOGIST
Credential: AU.D.
Phone: 916-627-1494