Provider Demographics
NPI:1164831426
Name:EXCEPTIONAL HEARING SERVICES OF NORTHERN CALIFORNIA, INC.
Entity Type:Organization
Organization Name:EXCEPTIONAL HEARING SERVICES OF NORTHERN CALIFORNIA, INC.
Other - Org Name:BELTONE OF NORTHERN CA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR. OF AUDIOLOGY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:415-499-7766
Mailing Address - Street 1:4340 REDWOOD HWY # A12
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2121
Mailing Address - Country:US
Mailing Address - Phone:415-499-7766
Mailing Address - Fax:415-491-1336
Practice Address - Street 1:4340 REDWOOD HWY # A12
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2121
Practice Address - Country:US
Practice Address - Phone:415-499-7766
Practice Address - Fax:415-491-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2679237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty