MEDICARE: JULIE MARIE LAURIDSEN AUD

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	2201000599	VA

General Provider Information

NPI Number	:	1942297239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MARIE LAURIDSEN AUD

Provider Business Mailing Address
First Line	:	7905 CALUMET
Second Line	:	HAMMOND CLINIC LLC
City	:	MUNSTER
State	:	IN
Zip	:	46321-1215
Country	:	US
Telephone Number	:	219-836-5800
Fax Number	:	219-836-8073

Provider Business Practice Location Address
First Line	:	7905 CALUMET AVE
Second Line	:	HAMMOND CLINIC LLC
City	:	MUNSTER
State	:	IN
Zip	:	46321-1215
Country	:	US
Telephone Number	:	219-836-5800
Fax Number	:	219-836-8073

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

Provider Enumeration Date	:	10/01/2005
Last Update Date	:	08/29/2008

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