Provider Demographics
NPI:1174856132
Name:MOUNTAIN VIEW AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:MCDILL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD CCC-A
Authorized Official - Phone:307-266-4100
Mailing Address - Street 1:301 S FENWAY ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3051
Mailing Address - Country:US
Mailing Address - Phone:307-266-4100
Mailing Address - Fax:307-266-4106
Practice Address - Street 1:301 S FENWAY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3051
Practice Address - Country:US
Practice Address - Phone:307-266-4100
Practice Address - Fax:307-266-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA-928261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech