Provider Demographics
NPI:1083295323
Name:NORTHERN KENTUCKY AUDIOLOGY
Entity Type:Organization
Organization Name:NORTHERN KENTUCKY AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIST
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:859-342-5846
Mailing Address - Street 1:463 ERLANGER RD
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1427
Mailing Address - Country:US
Mailing Address - Phone:859-342-5846
Mailing Address - Fax:
Practice Address - Street 1:463 ERLANGER RD
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1427
Practice Address - Country:US
Practice Address - Phone:859-342-5846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty