Provider Demographics
NPI:1205094307
Name:HALES, LAINIE D (AUD)
Entity type:Individual
Prefix:DR
First Name:LAINIE
Middle Name:D
Last Name:HALES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LAINIE
Other - Middle Name:D
Other - Last Name:TENNANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2222 E. HIGHLAND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4876
Mailing Address - Country:US
Mailing Address - Phone:602-257-4219
Mailing Address - Fax:602-257-8319
Practice Address - Street 1:1520 S. DOBSON ROAD
Practice Address - Street 2:SUITE 305
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-539-4000
Practice Address - Fax:480-833-3040
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA4669237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
124100Medicare PIN