Provider Demographics
NPI:1689621757
Name:AUDIOLOGY AND HEARING CLINIC
Entity Type:Organization
Organization Name:AUDIOLOGY AND HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:HELLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:435-789-0709
Mailing Address - Street 1:91 N 100 W
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2011
Mailing Address - Country:US
Mailing Address - Phone:435-789-0709
Mailing Address - Fax:435-781-8226
Practice Address - Street 1:91 N 100 W
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2011
Practice Address - Country:US
Practice Address - Phone:435-789-0709
Practice Address - Fax:435-781-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT308266-4101305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT647052593002Medicaid