Provider Demographics
NPI:1093415515
Name:LAKE AUDIOLOGY INC
Entity Type:Organization
Organization Name:LAKE AUDIOLOGY INC
Other - Org Name:FOREST AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, PHD
Authorized Official - Phone:434-266-9898
Mailing Address - Street 1:15243 FOREST RD STE D
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4974
Mailing Address - Country:US
Mailing Address - Phone:434-266-9898
Mailing Address - Fax:434-266-9848
Practice Address - Street 1:15243 FOREST RD STE D
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4974
Practice Address - Country:US
Practice Address - Phone:434-266-9898
Practice Address - Fax:434-266-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty