Healthcare Provider Details

I. General information

NPI: 1326690470
Provider Name (Legal Business Name): ALTITUDE AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 CREEKSIDE PARK RD STE 107
SPRING BRANCH TX
78070-6226
US

IV. Provider business mailing address

172 CREEKSIDE PARK RD STE 107
SPRING BRANCH TX
78070-6226
US

V. Phone/Fax

Practice location:
  • Phone: 830-438-7766
  • Fax:
Mailing address:
  • Phone: 830-438-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MACKENZIE THOMAS
Title or Position: AUDIOLOGIST/OWNER
Credential:
Phone: 210-381-6609