Provider Demographics
NPI:1003327719
Name:INNOVATIVE AUDIOLOGY AND HEARING CLINIC LLC
Entity type:Organization
Organization Name:INNOVATIVE AUDIOLOGY AND HEARING CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:602-283-3823
Mailing Address - Street 1:7629 E PINNACLE PEAK RD STE 118
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6292
Mailing Address - Country:US
Mailing Address - Phone:602-283-3823
Mailing Address - Fax:480-701-8604
Practice Address - Street 1:7629 E PINNACLE PEAK RD STE 118
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6292
Practice Address - Country:US
Practice Address - Phone:602-283-3823
Practice Address - Fax:480-701-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332S00000X, 332S00000X
AZ261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty