Provider Demographics
NPI:1487194940
Name:MODERN AUDIOLOGY
Entity Type:Organization
Organization Name:MODERN AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELLS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:303-988-7299
Mailing Address - Street 1:7373 W JEFFERSON AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7373 W JEFFERSON AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2038
Practice Address - Country:US
Practice Address - Phone:303-988-7299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO797231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty