Healthcare Provider Details

I. General information

NPI: 1356554497
Provider Name (Legal Business Name): ALENA A FREEMAN M.CL.SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11905 JOHN K HALL WAY
CHARLOTTE NC
28277-2855
US

IV. Provider business mailing address

11905 JOHN K HALL WAY
CHARLOTTE NC
28277-2855
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-7547
  • Fax:
Mailing address:
  • Phone: 704-544-7547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number6282
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: