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General NPI Number Information
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NPI Number | 1639843006
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Entity Type | Organization
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Legal Business Name | KENSINGTON AUDIOLOGY, LLC
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 11014 GLUECK LN
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City | KENSINGTON
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State | MD
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Zip | 20895-1618
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Country | US
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Telephone | 301-221-2208
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Fax |
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Provider Business Mailing Address
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Address Line | 11014 GLUECK LN
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City | KENSINGTON
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State | MD
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Zip | 20895-1618
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Country | US
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Telephone | 301-221-2208
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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. MADELEINE CISSNA
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Credential | AU.D.
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Telephone | 301-221-2208
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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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