Provider Demographics
NPI:1720530496
Name:PURE AUDIOLOGY LLC
Entity Type:Organization
Organization Name:PURE AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:JB
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:802-318-0138
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-0186
Mailing Address - Country:US
Mailing Address - Phone:802-318-0138
Mailing Address - Fax:866-649-2238
Practice Address - Street 1:64 KNIGHT LN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9480
Practice Address - Country:US
Practice Address - Phone:802-318-0138
Practice Address - Fax:866-649-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty