Healthcare Provider Details

I. General information

NPI: 1720695752
Provider Name (Legal Business Name): KATHRYN E HULL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7926 W JEFFERSON BLVD
FORT WAYNE IN
46804-4140
US

IV. Provider business mailing address

10021 DUPONT CIRCLE CT
FORT WAYNE IN
46825-1604
US

V. Phone/Fax

Practice location:
  • Phone: 260-426-8117
  • Fax:
Mailing address:
  • Phone: 260-426-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002737A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: