Provider Demographics
NPI:1578552154
Name:AUDIOLOGY SERVICES OF NORTHERN CALIFORNIA INC
Entity Type:Organization
Organization Name:AUDIOLOGY SERVICES OF NORTHERN CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:209-634-9327
Mailing Address - Street 1:2330 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2013
Mailing Address - Country:US
Mailing Address - Phone:209-634-9327
Mailing Address - Fax:209-634-3037
Practice Address - Street 1:2330 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2013
Practice Address - Country:US
Practice Address - Phone:209-634-9327
Practice Address - Fax:209-634-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1782231H00000X
CAHA3831237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0017820Medicaid
CAAU0017820Medicaid