Provider Demographics
NPI:1760426738
Name:ATLANTIC AUDIOLOGY, INCORPORATED
Entity Type:Organization
Organization Name:ATLANTIC AUDIOLOGY, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOLEATA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WIGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A, FAAA
Authorized Official - Phone:781-246-0305
Mailing Address - Street 1:979 -983 MAIN ST
Mailing Address - Street 2:GREENWOOD PLAZA
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3990
Mailing Address - Country:US
Mailing Address - Phone:781-246-0305
Mailing Address - Fax:781-246-7576
Practice Address - Street 1:979-983 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3978
Practice Address - Country:US
Practice Address - Phone:781-246-0305
Practice Address - Fax:781-246-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA356231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
043064Medicare ID - Type Unspecified