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General NPI Number Information
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NPI Number | 1104666098
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Entity Type | Organization
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Legal Business Name | MODERN TINNITUS LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1717 E MORTEN AVE UNIT 10
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City | PHOENIX
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State | AZ
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Zip | 85020-4752
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Country | US
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Telephone | 636-219-1353
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 E MORTEN AVE UNIT 10
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City | PHOENIX
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State | AZ
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Zip | 85020-4752
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Country | US
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Telephone | 636-219-1353
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. ASHLEY D. OLSON
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Credential |
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Telephone | 636-219-9635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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