Healthcare Provider Details

I. General information

NPI: 1588628994
Provider Name (Legal Business Name): JUDITH ANN SMITH CCC A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 13TH ST HEARING UNLIMITED
AMES IA
50010
US

IV. Provider business mailing address

118 E 13TH ST
AMES IA
50010
US

V. Phone/Fax

Practice location:
  • Phone: 515-233-1367
  • Fax: 515-233-1012
Mailing address:
  • Phone: 515-233-1367
  • Fax: 515-233-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number251
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number126
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: