Provider Demographics
NPI:1922404524
Name:PENDLEBURY, DANIEL ERIC (AUD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ERIC
Last Name:PENDLEBURY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MARJACQ AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4016
Mailing Address - Country:US
Mailing Address - Phone:208-406-6925
Mailing Address - Fax:
Practice Address - Street 1:700 E 17TH ST
Practice Address - Street 2:ATTN: HEARING AID CENTER
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6152
Practice Address - Country:US
Practice Address - Phone:208-406-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-2632231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist