MEDICARE: HUMBOLDT AUDIOLOGY, PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669684155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMBOLDT AUDIOLOGY, PC

Provider Business Mailing Address
First Line	:	831 HARRIS ST STE D
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95503-4541
Country	:	US
Telephone Number	:	707-443-7111
Fax Number	:	707-443-7117

Provider Business Practice Location Address
First Line	:	831 HARRIS ST STE D
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95503-4541
Country	:	US
Telephone Number	:	707-443-7111
Fax Number	:	707-443-7117

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. EMILY A. WEBER
Credential	:	MA
Telephone Number	:	707-443-7111

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/30/2016

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