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General NPI Number Information
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NPI Number | 1134528375
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Entity Type | Organization
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Legal Business Name | ADVANCED AUDIOLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 912 MERAMEC STATION RD STE F
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City | VALLEY PARK
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State | MO
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Zip | 63088-2045
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Country | US
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Telephone | 618-939-6861
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Fax |
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Provider Business Mailing Address
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Address Line | 912 MERAMEC STATION RD STE F
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City | VALLEY PARK
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State | MO
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Zip | 63088-2045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF AUDIOLOGY/OWNER
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Name | DR. BRANDI PETTIS
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Credential | AU.D.
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Telephone | 803-549-6077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2013008765
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License Number State | MO
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