Provider Demographics
NPI:1710201769
Name:ADVANCED AUDIOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED AUDIOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:BONT
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-A
Authorized Official - Phone:810-388-9400
Mailing Address - Street 1:3158 GRATIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1488
Mailing Address - Country:US
Mailing Address - Phone:810-388-9400
Mailing Address - Fax:810-388-9434
Practice Address - Street 1:3158 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1488
Practice Address - Country:US
Practice Address - Phone:810-388-9400
Practice Address - Fax:810-388-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000490237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E01107OtherMICHIGAN BCBS
0E01107OtherMICHIGAN BCBS