Healthcare Provider Details

I. General information

NPI: 1669610291
Provider Name (Legal Business Name): AUDIOLOGY AND HEARING AID SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 FOREST AVE
PORTLAND ME
04103-3303
US

IV. Provider business mailing address

985 FOREST AVE
PORTLAND ME
04103-3303
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-8738
  • Fax:
Mailing address:
  • Phone: 207-797-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP1825
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberDL20000383
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP25
License Number StateME

VIII. Authorized Official

Name: MELISSA VANDENBURGH
Title or Position: OFFICE MANAGER
Credential:
Phone: 207-797-8738