Provider Demographics
NPI:1093066441
Name:LEE M. WEISSMAN, AU.D, AUDIOLOGIST PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LEE M. WEISSMAN, AU.D, AUDIOLOGIST PROFESSIONAL CORPORATION
Other - Org Name:HEAR SO GOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:415-456-4327
Mailing Address - Street 1:2154 4TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2684
Mailing Address - Country:US
Mailing Address - Phone:415-456-4327
Mailing Address - Fax:415-524-4227
Practice Address - Street 1:505 SAN MARIN DR STE A130
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-1372
Practice Address - Country:US
Practice Address - Phone:415-456-4327
Practice Address - Fax:415-480-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2748231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR229AMedicare PIN