Provider Demographics
NPI:1912372418
Name:AVADA AUDIOLOGY AND HEARING CARE
Entity Type:Organization
Organization Name:AVADA AUDIOLOGY AND HEARING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAEUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-514-4322
Mailing Address - Street 1:813 FOX LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4511
Mailing Address - Country:US
Mailing Address - Phone:262-514-4322
Mailing Address - Fax:
Practice Address - Street 1:813 FOX LANE SUITE B
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53404
Practice Address - Country:US
Practice Address - Phone:262-514-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI143860305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization