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General NPI Number Information
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NPI Number | 1699553578
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Entity Type | Organization
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Legal Business Name | LEGACY AUDIOLOGY
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 1038 CYPRESS CIR
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4100
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Country | US
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Telephone | 307-371-0789
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 HILLTOP DR STE 105
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-5858
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Country | US
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Telephone | 307-522-5410
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Fax |
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Authorized Official
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Title or Position | CO-OWER/ AUDIOLOGIST
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Name | LIBBY MEHLE
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Credential | AUD
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Telephone | 307-371-0789
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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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