Provider Demographics
NPI:1669610291
Name:AUDIOLOGY AND HEARING AID SERVICES, LLC
Entity type:Organization
Organization Name:AUDIOLOGY AND HEARING AID SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-797-8738
Mailing Address - Street 1:985 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3303
Mailing Address - Country:US
Mailing Address - Phone:207-797-8738
Mailing Address - Fax:
Practice Address - Street 1:985 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3303
Practice Address - Country:US
Practice Address - Phone:207-797-8738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP1825231H00000X
MEDL20000383237700000X
MEAP25231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty