Healthcare Provider Details

I. General information

NPI: 1205067113
Provider Name (Legal Business Name): THE AUDIOLOGY CENTER OF LORAIN CO. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 S BROADWAY SUITE 102
LORAIN OH
44053-3875
US

IV. Provider business mailing address

6100 S BROADWAY SUITE-102 THE AUDIOLOGY CENTER
LORAIN OH
44053-3875
US

V. Phone/Fax

Practice location:
  • Phone: 440-246-4327
  • Fax: 440-246-4327
Mailing address:
  • Phone: 440-246-4327
  • Fax: 440-246-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA0171
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MRS. LILLIAN REYNOLDS MITHCHELL
Title or Position: PRESIDENT-OWNER-AUDIOLOGIST
Credential: MA-CCCA FAAA
Phone: 440-246-4327