MEDICARE: ALLISON AUDIOLOGY & HEARING AID CENTER - LAKE JACKSON, P.C.

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	80140	TX

General Provider Information

NPI Number	:	1801375795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLISON AUDIOLOGY & HEARING AID CENTER - LAKE JACKSON, P.C.

Provider Business Mailing Address
First Line	:	104 CIRCLE WAY ST STE D
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5200
Country	:	US
Telephone Number	:	979-292-8501
Fax Number	:	979-292-8505

Provider Business Practice Location Address
First Line	:	104 CIRCLE WAY ST STE D
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5200
Country	:	US
Telephone Number	:	979-292-8501
Fax Number	:	979-292-8505

Authorized Official
Title or Position	:	OWNER
Name	:	JANA EMOLA-AUSTIN
Credential	:	AUD
Telephone Number	:	979-292-8501

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	07/17/2023

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