Provider Demographics
NPI:1699822106
Name:CLINICAL AUDIOLOGY OF LOUISVILLE
Entity Type:Organization
Organization Name:CLINICAL AUDIOLOGY OF LOUISVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:II
Authorized Official - Credentials:AUD
Authorized Official - Phone:502-893-5105
Mailing Address - Street 1:3999 DUTCHMANS LN
Mailing Address - Street 2:SUBURBAN MEDICAL PLAZA I STE 4C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4736
Mailing Address - Country:US
Mailing Address - Phone:502-893-5105
Mailing Address - Fax:502-893-5104
Practice Address - Street 1:3999 DUTCHMANS LN
Practice Address - Street 2:SUBURBAN MEDICAL PLAZA I STE 4C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4736
Practice Address - Country:US
Practice Address - Phone:502-893-5105
Practice Address - Fax:502-893-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0322231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY640587001OtherRAILROAD MEDICARE
KY9114Medicare PIN
KY640587001OtherRAILROAD MEDICARE