=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346797891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KLECKNER AUDIOLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2016
-----------------------------------------------------
Last Update Date | 12/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3131 COLLEGE HEIGHTS BLVD STE 2600
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-4878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-435-8299
-----------------------------------------------------
Fax | 610-435-1940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3131 COLLEGE HEIGHTS BLVD STE 2600
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-4878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-435-8299
-----------------------------------------------------
Fax | 610-435-1940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST
-----------------------------------------------------
Name | DR. PETER DAVID KLECKNER
-----------------------------------------------------
Credential | AU.D.
-----------------------------------------------------
Telephone | 610-435-8299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------