Provider Demographics
NPI:1770007056
Name:WASHBURN AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:WASHBURN AUDIOLOGY, LLC
Other - Org Name:LOVE TO HEAR AGAIN AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:501-305-9358
Mailing Address - Street 1:1125 S BALL ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4038
Mailing Address - Country:US
Mailing Address - Phone:817-722-6156
Mailing Address - Fax:817-722-6159
Practice Address - Street 1:1125 S BALL ST STE 105
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4038
Practice Address - Country:US
Practice Address - Phone:817-722-6156
Practice Address - Fax:817-722-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80854231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty