Provider Demographics
NPI:1952636854
Name:ADIRONDACK AUDIOLOGY ASSOCIATES HEARING AND BALANCE CENTER LLC
Entity Type:Organization
Organization Name:ADIRONDACK AUDIOLOGY ASSOCIATES HEARING AND BALANCE CENTER LLC
Other - Org Name:ADIRONDACK AUDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-922-9545
Mailing Address - Street 1:10 MARSETT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7150
Mailing Address - Country:US
Mailing Address - Phone:802-922-9545
Mailing Address - Fax:802-922-9546
Practice Address - Street 1:10 MARSETT RD STE 3
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7150
Practice Address - Country:US
Practice Address - Phone:802-922-9545
Practice Address - Fax:802-922-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1952636854OtherTYPE II NPI
VT1952636854OtherTYPE II NPI