Provider Demographics
NPI:1336454958
Name:LAKESIDE AUDIOLOGY LLC
Entity Type:Organization
Organization Name:LAKESIDE AUDIOLOGY LLC
Other - Org Name:HEARING ZONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:TURGOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:801-444-0300
Mailing Address - Street 1:70 S FAIRFIELD RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5111
Mailing Address - Country:US
Mailing Address - Phone:801-444-0300
Mailing Address - Fax:801-547-6392
Practice Address - Street 1:70 S FAIRFIELD RD
Practice Address - Street 2:SUITE 10
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5111
Practice Address - Country:US
Practice Address - Phone:801-444-0300
Practice Address - Fax:801-547-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6502486-4101235Z00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000069890Medicare UPIN