Healthcare Provider Details

I. General information

NPI: 1972680619
Provider Name (Legal Business Name): PRISCILLA DOUGLAS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FANNY ALLEN AUDIOLOGY 790 COLLEGE PARKWAY
COLCHESTER VT
05446
US

IV. Provider business mailing address

143 SPRUCE ST
BURLINGTON VT
05401-4523
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3970
  • Fax: 802-847-5880
Mailing address:
  • Phone: 802-658-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: