=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972790236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL BEND HEARING CLINIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2007
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1016 S COMMERCIAL ST
-----------------------------------------------------
City | ARANSAS PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78336-5306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-758-0376
-----------------------------------------------------
Fax | 361-758-0378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 611
-----------------------------------------------------
City | ARANSAS PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78335-0611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-758-0376
-----------------------------------------------------
Fax | 361-758-0378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAKSHA K KALIES
-----------------------------------------------------
Credential | AU.D
-----------------------------------------------------
Telephone | 361-758-0376
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 51116
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------