Provider Demographics
NPI:1144608704
Name:UPPER PENINSULA AUDIOLOGY INC.
Entity Type:Organization
Organization Name:UPPER PENINSULA AUDIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:269-303-5333
Mailing Address - Street 1:901 W SHARON AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1964
Mailing Address - Country:US
Mailing Address - Phone:269-303-5333
Mailing Address - Fax:
Practice Address - Street 1:901 W SHARON AVE UNIT 9
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1964
Practice Address - Country:US
Practice Address - Phone:269-303-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000516231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty