Provider Demographics
NPI:1790010254
Name:WEBER AUDIOLOGY LLC
Entity Type:Organization
Organization Name:WEBER AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:801-627-3001
Mailing Address - Street 1:2510 WASHINGTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401
Mailing Address - Country:US
Mailing Address - Phone:801-627-3001
Mailing Address - Fax:801-627-3001
Practice Address - Street 1:2510 WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401
Practice Address - Country:US
Practice Address - Phone:801-627-3001
Practice Address - Fax:801-627-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA-929231H00000X
UT103949-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1174550800Medicaid
WYW306906Medicare UPIN
WY1174550800Medicaid