Healthcare Provider Details

I. General information

NPI: 1043209737
Provider Name (Legal Business Name): KATHLEEN ANN GALLION AU D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANN ANDOLSEK

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8468 HERRING RUN RD
SEAFORD DE
19973-5763
US

IV. Provider business mailing address

9 CANDYTUFT LN
OCEAN PINES MD
21811-2050
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-3400
  • Fax: 302-629-5300
Mailing address:
  • Phone: 443-496-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number02-0000155
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number03-0000229
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: