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General NPI Number Information
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NPI Number | 1316167620
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Entity Type | Organization
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Legal Business Name | K J GORMAN, LLC
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 267 WYNNEWOOD VILLAGE
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City | DALLAS
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State | TX
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Zip | 75224
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Country | US
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Telephone | 214-948-3273
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Fax | 214-942-4114
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Provider Business Mailing Address
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Address Line | 267 WYNNEWOOD VILLAGE
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City | DALLAS
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State | TX
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Zip | 75224
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Country | US
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Telephone | 214-948-3273
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Fax | 214-942-4114
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. KATHY JEAN GORMAN
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Credential | AUD CCC A
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Telephone | 214-948-3273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 51598
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License Number State | TX
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