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General NPI Number Information
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NPI Number | 1376096644
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Entity Type | Organization
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Legal Business Name | WOLFPACK HEARING CLINIC, PLLC
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 2630 E CITIZENS DR STE 7
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4797
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Country | US
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Telephone | 479-957-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 E CITIZENS DR STE 7
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4797
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Country | US
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Telephone | 479-957-9300
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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 | DR. DUSTIN RICHARDS
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Credential | AU.D.
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Telephone | 479-957-9300
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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 | A#373
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License Number State | AR
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