Healthcare Provider Details

I. General information

NPI: 1639472715
Provider Name (Legal Business Name): AUDIOLOGY ASSOCIATES OF HAMMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15706 PROFESSIONAL PLZ
HAMMOND LA
70403-1451
US

IV. Provider business mailing address

15706 PROFESSIONAL PLZ
HAMMOND LA
70403-1451
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-2521
  • Fax: 985-542-0474
Mailing address:
  • Phone: 985-542-2521
  • Fax: 985-542-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE KELLEY
Title or Position: BILLING/CREDENTIALING MGR
Credential:
Phone: 985-542-2521