Provider Demographics
NPI:1437464195
Name:COOSA VALLEY HEARING CLINIC, INC
Entity Type:Organization
Organization Name:COOSA VALLEY HEARING CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-A
Authorized Official - Phone:256-249-0943
Mailing Address - Street 1:208 W FORT WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2432
Mailing Address - Country:US
Mailing Address - Phone:256-249-0943
Mailing Address - Fax:256-249-0941
Practice Address - Street 1:208 W FORT WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2432
Practice Address - Country:US
Practice Address - Phone:256-249-0943
Practice Address - Fax:256-249-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL892A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty