MEDICARE: DR. KELLY JEAN HALTERMAN AU.D.

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	DA7844	AZ

General Provider Information

NPI Number	:	1750645073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY JEAN HALTERMAN AU.D.

Provider Business Mailing Address
First Line	:	22425 N 96TH LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-4194
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8877 W UNION HILLS DR STE 350
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3026
Country	:	US
Telephone Number	:	623-428-0727
Fax Number	:	623-738-3918

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

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	03/21/2023

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