Provider Demographics
NPI:1659841203
Name:LAND AUDIOLOGY PLLC
Entity Type:Organization
Organization Name:LAND AUDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MICHELLE MENDEZ
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:512-925-0965
Mailing Address - Street 1:1500 BARBARA STREET
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1302
Mailing Address - Country:US
Mailing Address - Phone:512-925-0965
Mailing Address - Fax:
Practice Address - Street 1:7509 MENCHACA RD UNIT 302
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6061
Practice Address - Country:US
Practice Address - Phone:512-829-8690
Practice Address - Fax:512-661-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80796OtherSTATE LICENSE