Provider Demographics
NPI:1457905911
Name:WATERVILLE AUDIOLOGY PC
Entity Type:Organization
Organization Name:WATERVILLE AUDIOLOGY PC
Other - Org Name:WATERVILLE AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-577-3310
Mailing Address - Street 1:105 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5131
Mailing Address - Country:US
Mailing Address - Phone:207-872-0320
Mailing Address - Fax:207-872-0330
Practice Address - Street 1:105 KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5131
Practice Address - Country:US
Practice Address - Phone:207-872-0320
Practice Address - Fax:207-872-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty