MEDICARE: WINDSOR AUDIOLOGY 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	772	CO

General Provider Information

NPI Number	:	1295288652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDSOR AUDIOLOGY LLC

Provider Business Mailing Address
First Line	:	8201 SPINNAKER BAY DR
Second Line	:	STE E
City	:	WINDSOR
State	:	CO
Zip	:	80528-7533
Country	:	US
Telephone Number	:	970-682-1950
Fax Number	:

Provider Business Practice Location Address
First Line	:	8201 SPINNAKER BAY DR
Second Line	:	STE E
City	:	WINDSOR
State	:	CO
Zip	:	80528-7533
Country	:	US
Telephone Number	:	970-682-1950
Fax Number	:

Authorized Official
Title or Position	:	AUDIOLOGIST/OWNER
Name	:	DR. LEANN JOHNSON
Credential	:	AU.D.
Telephone Number	:	970-682-1950

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	09/14/2016

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