Provider Demographics
NPI:1609117126
Name:ASHLAND AUDIOLOGY LLC
Entity Type:Organization
Organization Name:ASHLAND AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLZHAEUSER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:715-682-9311
Mailing Address - Street 1:2101 BEASER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3632
Mailing Address - Country:US
Mailing Address - Phone:715-682-9311
Mailing Address - Fax:715-682-9313
Practice Address - Street 1:2101 BEASER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3632
Practice Address - Country:US
Practice Address - Phone:715-682-9311
Practice Address - Fax:715-682-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI83-156261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
P26316Medicare UPIN