Provider Demographics
NPI:1891815759
Name:HEARD IT THROUGH THE GRAPEVINE AUDIOLOGY, PC
Entity Type:Organization
Organization Name:HEARD IT THROUGH THE GRAPEVINE AUDIOLOGY, PC
Other - Org Name:GRAPEVINE AUDIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:817-488-1637
Mailing Address - Street 1:190 S PEYTONVILLE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6937
Mailing Address - Country:US
Mailing Address - Phone:817-488-1637
Mailing Address - Fax:817-488-2854
Practice Address - Street 1:190 S PEYTONVILLE AVE STE 120
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6937
Practice Address - Country:US
Practice Address - Phone:817-488-1637
Practice Address - Fax:817-488-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51647231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty