Provider Demographics
NPI:1669684155
Name:HUMBOLDT AUDIOLOGY, PC
Entity Type:Organization
Organization Name:HUMBOLDT AUDIOLOGY, PC
Other - Org Name:HUMBOLDT AUDIOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:707-443-7111
Mailing Address - Street 1:831 HARRIS ST STE D
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4541
Mailing Address - Country:US
Mailing Address - Phone:707-443-7111
Mailing Address - Fax:707-443-7117
Practice Address - Street 1:831 HARRIS ST STE D
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4541
Practice Address - Country:US
Practice Address - Phone:707-443-7111
Practice Address - Fax:707-443-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0023640Medicaid
CAAU0023640Medicaid