MEDICARE: MRS. JUDITH HERZ CONLEY M.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	AU2436	CA
2	237600000X	Audiologist-Hearing Aid Fitter	HT8114	CA
3	237700000X	Hearing Instrument Specialist	AU2436	CA
4	231H00000X	Audiologist	12108	NC

General Provider Information

NPI Number	:	1891882353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH HERZ CONLEY M.A.

Provider Business Mailing Address
First Line	:	7810 BALLANTYNE COMMONS PKWY STE 210
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3416
Country	:	US
Telephone Number	:	704-544-2274
Fax Number	:	704-542-2285

Provider Business Practice Location Address
First Line	:	7810 BALLANTYNE COMMONS PKWY STE 210
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3416
Country	:	US
Telephone Number	:	704-544-2274
Fax Number	:	704-542-2285

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	10/19/2021

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