Provider Demographics
NPI:1407058266
Name:CAROL KATHLEEN FREE, AUDIOLOGIST
Entity Type:Organization
Organization Name:CAROL KATHLEEN FREE, AUDIOLOGIST
Other - Org Name:IN HOME HEARING CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, AUDIOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:831-336-4444
Mailing Address - Street 1:245 MOUNT HERMON RD STE M
Mailing Address - Street 2:SUITE 149
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4045
Mailing Address - Country:US
Mailing Address - Phone:831-336-4444
Mailing Address - Fax:831-604-1405
Practice Address - Street 1:245 MOUNT HERMON RD STE M
Practice Address - Street 2:SUITE 149
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4045
Practice Address - Country:US
Practice Address - Phone:831-336-4444
Practice Address - Fax:831-604-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU635231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04715ZMedicare PIN
CAZZZ03688ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAZZZ04712ZMedicare PIN
CAZZZ04713ZMedicare PIN
CAZZZ04709ZMedicare PIN
CAZZZ04714ZMedicare PIN