Healthcare Provider Details

I. General information

NPI: 1780177873
Provider Name (Legal Business Name): EAVESDROP AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81B CENTER RD
ESSEX VT
05452-2604
US

IV. Provider business mailing address

81B CENTER RD
ESSEX VT
05452-2604
US

V. Phone/Fax

Practice location:
  • Phone: 802-307-9567
  • Fax: 802-307-9567
Mailing address:
  • Phone: 802-307-9567
  • Fax: 802-307-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW D. CROSS
Title or Position: AUDIOLOGIST
Credential: AU.D.
Phone: 802-307-9567