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General NPI Number Information
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NPI Number | 1700130275
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Entity Type | Organization
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Legal Business Name | MCLEAN AUDIOLOGY
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 4402 VANCE JACKSON RD SUITE 156
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City | SAN ANTONIO
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State | TX
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Zip | 78230-5336
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Country | US
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Telephone | 210-341-0451
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Fax | 210-341-5834
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Provider Business Mailing Address
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Address Line | 4402 VANCE JACKSON RD SUITE 156
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City | SAN ANTONIO
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State | TX
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Zip | 78230-5336
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Country | US
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Telephone | 210-341-0451
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Fax | 210-341-5834
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Authorized Official
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Title or Position | OWNER
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Name | DR. JODI MCLEAN
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Credential | AU.D.
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Telephone | 210-341-0451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 50528
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License Number State | TX
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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 | 50528
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License Number State | TX
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