Provider Demographics
NPI:1851556104
Name:AFFILIATED AUDIOLOGY CONSULTANTS, INC.
Entity Type:Organization
Organization Name:AFFILIATED AUDIOLOGY CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:602-254-6041
Mailing Address - Street 1:4638 E SHEA BLVD
Mailing Address - Street 2:STE. B-170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3072
Mailing Address - Country:US
Mailing Address - Phone:602-254-6041
Mailing Address - Fax:602-254-6735
Practice Address - Street 1:4638 E SHEA BLVD
Practice Address - Street 2:STE. B-170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3072
Practice Address - Country:US
Practice Address - Phone:602-254-6041
Practice Address - Fax:602-254-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA719231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZNGBBSMedicare PIN