Provider Demographics
NPI:1295747905
Name:LAACK, TODD ANTHONY (AUD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANTHONY
Last Name:LAACK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33910
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3910
Mailing Address - Country:US
Mailing Address - Phone:702-735-7668
Mailing Address - Fax:702-735-1411
Practice Address - Street 1:3692 E SUNSET RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-7237
Practice Address - Country:US
Practice Address - Phone:702-735-7668
Practice Address - Fax:702-735-1411
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-249231H00000X, 237600000X, 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