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General NPI Number Information
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NPI Number | 1659523694
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Entity Type | Organization
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Legal Business Name | TETON HEARING CENTER LLC
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 50 SKI HILL RD.
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City | DRIGGS
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State | ID
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Zip | 83422
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Country | US
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Telephone | 208-569-8787
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Fax | 208-354-2656
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Provider Business Mailing Address
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Address Line | P.O. BOX 692
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City | DRIGGS
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State | ID
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Zip | 83422
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Country | US
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Telephone | 208-569-8787
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Fax | 208-354-2656
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Authorized Official
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Title or Position | MANAGER/MEMBER/AUDIOLOGIST
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Name | ELIZA S. PETERSEN
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Credential | M.A. CCC-A FAAA
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Telephone | 208-569-8787
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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 | AUD1142
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | A-974
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AUD1142
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | A-974
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License Number State | WY
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