Provider Demographics
NPI:1265637672
Name:AUDIOLOGY ASSOCIATES HEARING CENTER
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:COLEY
Authorized Official - Last Name:BRIDGER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:530-272-2247
Mailing Address - Street 1:101 MARGARET LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4207
Mailing Address - Country:US
Mailing Address - Phone:530-272-2247
Mailing Address - Fax:530-272-4120
Practice Address - Street 1:101 MARGARET LN
Practice Address - Street 2:SUITE D
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4207
Practice Address - Country:US
Practice Address - Phone:530-272-2247
Practice Address - Fax:530-272-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU305237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0010700Medicaid