Healthcare Provider Details

I. General information

NPI: 1851817399
Provider Name (Legal Business Name): APPLETON AUDIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 E GREEN BAY ST
SHAWANO WI
54166-2293
US

IV. Provider business mailing address

1520 N MEADE ST
APPLETON WI
54911-3762
US

V. Phone/Fax

Practice location:
  • Phone: 715-524-4242
  • Fax:
Mailing address:
  • Phone: 920-734-7181
  • Fax: 920-734-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS PARRY
Title or Position: MANAGER
Credential: AU.D.
Phone: 920-475-2331