Healthcare Provider Details

I. General information

NPI: 1437575057
Provider Name (Legal Business Name): LARAMIE HEARING AID CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MCCOLLUM ST STE 107
LARAMIE WY
82070-5151
US

IV. Provider business mailing address

204 MCCOLLUM ST STE 107
LARAMIE WY
82070-5151
US

V. Phone/Fax

Practice location:
  • Phone: 307-742-4327
  • Fax:
Mailing address:
  • Phone: 307-742-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number175
License Number StateWY

VIII. Authorized Official

Name: LISA LEVIN
Title or Position: OWNER/HEARING AID SPECIALIST
Credential:
Phone: 307-742-4327