MEDICARE: LAURA G STEVENSON AUDIOLOGIST

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	:	1588983183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA G STEVENSON AUDIOLOGIST

Provider Business Mailing Address
First Line	:	2000 W UNIVERSITY AVE
Second Line	:	AC 104
City	:	MUNCIE
State	:	IN
Zip	:	47306-1022
Country	:	US
Telephone Number	:	765-285-8175
Fax Number	:	765-285-5623

Provider Business Practice Location Address
First Line	:	2000 W UNIVERSITY AVE
Second Line	:	AC 104
City	:	MUNCIE
State	:	IN
Zip	:	47306-1022
Country	:	US
Telephone Number	:	765-285-8175
Fax Number	:	765-285-5623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	02/10/2015

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