=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891975462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEAR AGAIN AUDIOLOGY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2007
-----------------------------------------------------
Last Update Date | 02/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16251 N CLEVELAND AVE STE 8
-----------------------------------------------------
City | NORTH FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33903-2176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-768-3078
-----------------------------------------------------
Fax | 239-997-8084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16251 N CLEVELAND AVE STE 8
-----------------------------------------------------
City | NORTH FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33903-2176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-768-3078
-----------------------------------------------------
Fax | 239-997-8084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF AUDIOLOGY/OWNER
-----------------------------------------------------
Name | DR. CRYSTAL MARIE BROUSSARD
-----------------------------------------------------
Credential | AU.D.
-----------------------------------------------------
Telephone | 239-768-3078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AY1198
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------