Provider Demographics
NPI:1720167588
Name:AUGLAIZE AUDIOLOGY INC.
Entity Type:Organization
Organization Name:AUGLAIZE AUDIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-A
Authorized Official - Phone:419-739-7575
Mailing Address - Street 1:801 BREWFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9394
Mailing Address - Country:US
Mailing Address - Phone:419-739-7575
Mailing Address - Fax:419-739-7577
Practice Address - Street 1:801 BREWFIELD DR
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9394
Practice Address - Country:US
Practice Address - Phone:419-739-7575
Practice Address - Fax:419-739-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007421631OtherAETNA
OH2513828Medicaid
OH000000342913OtherANTHEM
OH738875OtherBUCKEYE COMMUNITY HEALTH
OH0007421631OtherAETNA