Provider Demographics
NPI:1184174716
Name:AUDIOLOGY PROFESSIONAL SERVICES OF LA CANADA
Entity type:Organization
Organization Name:AUDIOLOGY PROFESSIONAL SERVICES OF LA CANADA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:IVORY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:818-928-1400
Mailing Address - Street 1:1434 FOOTHILL BLVD UNIT C
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2166
Mailing Address - Country:US
Mailing Address - Phone:818-928-1400
Mailing Address - Fax:626-963-7207
Practice Address - Street 1:1434 FOOTHILL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2107
Practice Address - Country:US
Practice Address - Phone:818-928-1400
Practice Address - Fax:626-963-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2924237600000X, 237700000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty