Provider Demographics
NPI:1033270087
Name:TREASURE COAST AUDIOLOGY INC
Entity Type:Organization
Organization Name:TREASURE COAST AUDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HACKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:772-334-2022
Mailing Address - Street 1:2340 NE DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-5952
Mailing Address - Country:US
Mailing Address - Phone:772-334-2022
Mailing Address - Fax:772-334-6757
Practice Address - Street 1:2340 NE DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957
Practice Address - Country:US
Practice Address - Phone:772-334-2022
Practice Address - Fax:772-334-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY403231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFEDERAL TAX ID