=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790238038
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUDITORY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2016
-----------------------------------------------------
Last Update Date | 08/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4934 PEACH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16509-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-868-5487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4934 PEACH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16509-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-868-5487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | KATY MIZIKOWSKI
-----------------------------------------------------
Credential | BC-HIS
-----------------------------------------------------
Telephone | 814-868-5487
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | D-01070
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------