Provider Demographics
NPI:1922127653
Name:AUDIOLOGY ASSOCIATES OF LANCASTER, L.L.C.
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES OF LANCASTER, L.L.C.
Other - Org Name:AUDIOLOGY ASSOCIATES OF LANCASTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CORRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:740-654-3571
Mailing Address - Street 1:1303 RIVER VALLEY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1669
Mailing Address - Country:US
Mailing Address - Phone:740-654-3571
Mailing Address - Fax:740-689-3277
Practice Address - Street 1:1303 RIVER VALLEY BLVD STE B
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1669
Practice Address - Country:US
Practice Address - Phone:740-654-3571
Practice Address - Fax:740-689-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01182231H00000X
OHA-01135231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAU9333541Medicare ID - Type Unspecified
OH2104681Medicaid