Healthcare Provider Details

I. General information

NPI: 1326298142
Provider Name (Legal Business Name): ALISON L LIUDAHL AU.D.,C.C.C.-A,F.A.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 OLD BRIDGE RD SUITE 103
LAKE RIDGE VA
22192-2495
US

IV. Provider business mailing address

PO BOX 7657
WOODBRIDGE VA
22195-7657
US

V. Phone/Fax

Practice location:
  • Phone: 703-499-8787
  • Fax: 703-499-8222
Mailing address:
  • Phone: 703-499-8787
  • Fax: 703-499-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001374
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: