MEDICARE: EXECUTIVE AUDIOLOGY GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist

General Provider Information

NPI Number	:	1134959182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXECUTIVE AUDIOLOGY GROUP LLC

Provider Business Mailing Address
First Line	:	6885 MESA RIDGE PKWY
Second Line	:	PMB 240
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1593
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 PRINTERS PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-6100
Country	:	US
Telephone Number	:	719-465-2372
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF AUDIOLOGY
Name	:	DR. BIANCA SOFIA LIQUORI
Credential	:	AUD
Telephone Number	:	719-751-6481

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	04/01/2026

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