Provider Demographics
NPI:1780792697
Name:AUDIOLOGY ASSOCIATES,LLC
Entity type:Organization
Organization Name:AUDIOLOGY ASSOCIATES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:724-728-3659
Mailing Address - Street 1:78 TUSCARAWAS RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1721
Mailing Address - Country:US
Mailing Address - Phone:724-728-3659
Mailing Address - Fax:724-728-3679
Practice Address - Street 1:78 TUSCARAWAS RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2231
Practice Address - Country:US
Practice Address - Phone:724-728-3659
Practice Address - Fax:724-728-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000235L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA89563OtherUNISON
PA360571OtherHIGHMARK BCBS
PA250221OtherUPMC
PA1036036OtherGATEWAY
PA1576172Medicaid
PA360571OtherHIGHMARK BCBS
PA89563OtherUNISON