Healthcare Provider Details

I. General information

NPI: 1649660689
Provider Name (Legal Business Name): FAMILY AUDIOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S MAIN ST SUITE 4
CELINA OH
45822-2413
US

IV. Provider business mailing address

950 S MAIN ST SUITE 4
CELINA OH
45822-2413
US

V. Phone/Fax

Practice location:
  • Phone: 419-584-2255
  • Fax: 419-584-0808
Mailing address:
  • Phone: 419-584-2255
  • Fax: 419-584-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: ELLEN HUNTER
Title or Position: CO-OWNER
Credential: AUD
Phone: 419-584-2255