Healthcare Provider Details

I. General information

NPI: 1811928062
Provider Name (Legal Business Name): MOBILE AUDIOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S EXECUTIVE DR SUITE 101
BROOKFIELD WI
53005-4216
US

IV. Provider business mailing address

100 CROSSING BLVD SUITE 300
FRAMINGHAM MA
01702-5555
US

V. Phone/Fax

Practice location:
  • Phone: 414-535-8134
  • Fax: 414-535-8135
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAURA L. TASSE
Title or Position: OWNER/PRESIDENT
Credential: AUD
Phone: 617-964-6681