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General NPI Number Information
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NPI Number | 1306595715
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Entity Type | Organization
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Legal Business Name | TAHOE FAMILY HEARING CLINIC, PC
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 2074 LAKE TAHOE BLVD
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6407
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Country | US
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Telephone | 530-318-4010
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Fax |
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Provider Business Mailing Address
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Address Line | 1285 APACHE AVE # 306
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96155-7672
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Country | US
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Telephone | 530-318-4010
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Fax |
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Authorized Official
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Title or Position | OWNER/AUDIOLOGIST
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Name | JENELLE SANDY
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Credential | AUD
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Telephone | 530-318-4010
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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 |
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License Number State |
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