MEDICARE: MRS. GAIL LYNN BOLTON AU.D.,CCC/A

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	00549	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CIGNA	OTHER	IA	426038405
2	CONNETICUT GENERAL	OTHER	IA	426038405
3	MIDLANDS	OTHER	IA	247106
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1710952106	OTHER	IA	WELLMARK

General Provider Information

NPI Number	:	1710952106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GAIL LYNN BOLTON AU.D.,CCC/A

Provider Business Mailing Address
First Line	:	907 LINCOLN CIR SE
Second Line	:
City	:	ORANGE CITY
State	:	IA
Zip	:	51041-1859
Country	:	US
Telephone Number	:	712-707-9585
Fax Number	:	712-707-9801

Provider Business Practice Location Address
First Line	:	909 LINCOLN CIR SE STE 2
Second Line	:
City	:	ORANGE CITY
State	:	IA
Zip	:	51041-1860
Country	:	US
Telephone Number	:	712-707-9585
Fax Number	:	712-707-9801

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	03/14/2018

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