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General NPI Number Information
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NPI Number | 1538563994
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Entity Type | Organization
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Legal Business Name | AUDIOLOGY & HEARING CARE OF SOUTHWEST FLORIDA LLC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 24810 BURNT PINE DR SUITE 2
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-1973
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Country | US
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Telephone | 239-462-4021
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Fax |
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Provider Business Mailing Address
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Address Line | 24810 BURNT PINE DR SUITE 2
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-1973
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Country | US
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Telephone | 239-462-4021
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST/PRESIDENT
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Name | DARLENE WELTON BALLEW
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Credential | AU.D.
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Telephone | 239-462-4021
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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 | AY1221
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License Number State | FL
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