=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730557992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KY HEARING CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2015
-----------------------------------------------------
Last Update Date | 09/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2706 AVENUE OF THE WOODS
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40241-6283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-302-1133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4912 US HIGHWAY 42 STE 103
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40222-6357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST, CO-OWNER
-----------------------------------------------------
Name | KATIE LEIGH AUSTIN
-----------------------------------------------------
Credential | AUD
-----------------------------------------------------
Telephone | 480-302-1133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------