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General NPI Number Information
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NPI Number | 1710201769
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Entity Type | Organization
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Legal Business Name | ADVANCED AUDIOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 03/19/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 3158 GRATIOT BLVD
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City | MARYSVILLE
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State | MI
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Zip | 48040-1488
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Country | US
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Telephone | 810-388-9400
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Fax | 810-388-9434
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Provider Business Mailing Address
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Address Line | 3158 GRATIOT BLVD
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City | MARYSVILLE
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State | MI
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Zip | 48040-1488
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Country | US
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Telephone | 810-388-9400
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Fax | 810-388-9434
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Authorized Official
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Title or Position | AUDIOLOGIST / OWNER
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Name | MRS. LISA DANIELLE BONT
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Credential | MA CCC-A
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Telephone | 810-388-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 1601000490
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License Number State | MI
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