Provider Demographics
NPI:1154817344
Name:SPACE CITY AUDIOLOGY PLLC
Entity Type:Organization
Organization Name:SPACE CITY AUDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMIN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:AUZENNE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:281-809-6008
Mailing Address - Street 1:17625 EL CAMINO REAL STE 155
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3085
Mailing Address - Country:US
Mailing Address - Phone:281-809-6008
Mailing Address - Fax:
Practice Address - Street 1:17625 EL CAMINO REAL STE 155
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-809-6008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech