=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952583742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AURICLE AUDIOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2007
-----------------------------------------------------
Last Update Date | 12/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 414 W LITTLER DR
-----------------------------------------------------
City | PUEBLO WEST
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81007-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-568-2251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 414 W LITTLER DR
-----------------------------------------------------
City | PUEBLO WEST
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81007-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-568-2251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RENEE H CICHON
-----------------------------------------------------
Credential | MA CCC-A
-----------------------------------------------------
Telephone | 719-568-2251
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 316
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------