Healthcare Provider Details

I. General information

NPI: 1417512682
Provider Name (Legal Business Name): ADVANCED AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 HASLETT RD
HASLETT MI
48840-8472
US

IV. Provider business mailing address

1536 HASLETT RD
HASLETT MI
48840-8472
US

V. Phone/Fax

Practice location:
  • Phone: 517-896-4452
  • Fax: 517-669-8070
Mailing address:
  • Phone: 517-896-4452
  • Fax: 517-669-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDY LAVERNE WRIGHT
Title or Position: MANAGER
Credential:
Phone: 517-669-8080