Healthcare Provider Details

I. General information

NPI: 1497932768
Provider Name (Legal Business Name): SENIOR AUDIOLOGY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W MAIN ST
BRIDGEPORT WV
26330-1715
US

IV. Provider business mailing address

132 W MAIN ST
BRIDGEPORT WV
26330-1715
US

V. Phone/Fax

Practice location:
  • Phone: 304-842-9229
  • Fax:
Mailing address:
  • Phone: 304-842-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JESSICA ARDEN ORRAHOOD
Title or Position: SOLE MEMBER
Credential: AU.D.
Phone: 304-842-9229