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General NPI Number Information
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NPI Number | 1831509900
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Entity Type | Organization
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Legal Business Name | ELITE AUDIOLOGY RESOURCES, PLLC
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 578 N KIMBALL AVE SUITE 140
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6883
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Country | US
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Telephone | 817-778-4934
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Fax | 817-380-3256
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Provider Business Mailing Address
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Address Line | 578 N KIMBALL AVE SUITE 140
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6883
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Country | US
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Telephone | 817-778-4934
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Fax | 817-380-3256
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMY BADSTUBNER
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Credential | AU.D.
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Telephone | 352-672-5357
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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 | 80477
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License Number State | TX
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