MEDICARE: AUDIOLOGY AT HOME

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	2264	KS
2	237600000X	Audiologist-Hearing Aid Fitter	1618	KS
3	231H00000X	Audiologist	2013040406	MO

General Provider Information

NPI Number	:	1629441209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY AT HOME

Provider Business Mailing Address
First Line	:	5540 OAKLEY AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-3240
Country	:	US
Telephone Number	:	816-695-0169
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 OAKLEY AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-3240
Country	:	US
Telephone Number	:	816-695-0169
Fax Number	:

Authorized Official
Title or Position	:	AUDIOLOGIST / OWNER
Name	:	DR. LEANNA RAE ESCOBAR
Credential	:	AU.D.
Telephone Number	:	816-695-0169

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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Directions to “AUDIOLOGY AT HOME ” Practice Location

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