Provider Demographics
NPI:1003281809
Name:ASHLAND AUDIOLOGY LLC
Entity Type:Organization
Organization Name:ASHLAND AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:MALINOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:715-682-9311
Mailing Address - Street 1:2101 BEASER AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3632
Mailing Address - Country:US
Mailing Address - Phone:715-682-9311
Mailing Address - Fax:715-682-9313
Practice Address - Street 1:11040 N STATE ROAD 77
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6391
Practice Address - Country:US
Practice Address - Phone:715-682-9311
Practice Address - Fax:715-682-9313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHLAND AUDIOLOGY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI83-156261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center