Provider Demographics
NPI:1255762373
Name:IVORY, KEVIN HARLAN (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HARLAN
Last Name:IVORY
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 FOOTHILL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2107
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
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-30
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2924231H00000X
CA2924237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist