Provider Demographics
NPI:1114006087
Name:GREENBRIER AUDIOLOGY AND HEARING AID SERVICES, INC.
Entity Type:Organization
Organization Name:GREENBRIER AUDIOLOGY AND HEARING AID SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:I
Authorized Official - Credentials:MS,CCC-A
Authorized Official - Phone:304-465-3058
Mailing Address - Street 1:150 DAWKINS DR
Mailing Address - Street 2:GREY ROCK PROFESSIONAL PARK
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9302
Mailing Address - Country:US
Mailing Address - Phone:304-647-4327
Mailing Address - Fax:304-647-4331
Practice Address - Street 1:150 DAWKINS DR
Practice Address - Street 2:GREY ROCK PROFESSIONAL PARK
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9302
Practice Address - Country:US
Practice Address - Phone:304-647-4327
Practice Address - Fax:304-647-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-003231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0160752000Medicaid
WV0160752000Medicaid