Provider Demographics
NPI:1245692920
Name:ALL GENERATIONS AUDIOLOGY, PLLC
Entity type:Organization
Organization Name:ALL GENERATIONS AUDIOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:JANE BERTELSEN
Authorized Official - Last Name:ESHLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:704-799-7925
Mailing Address - Street 1:621 E CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2572
Mailing Address - Country:US
Mailing Address - Phone:704-799-7925
Mailing Address - Fax:
Practice Address - Street 1:621 E CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2572
Practice Address - Country:US
Practice Address - Phone:704-799-7925
Practice Address - Fax:844-315-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10615231H00000X
332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty