Provider Demographics
NPI:1831733104
Name:BURLESON AUDIOLOGY CLINIC PLLC
Entity type:Organization
Organization Name:BURLESON AUDIOLOGY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:817-764-3077
Mailing Address - Street 1:121 NW ELLISON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4782
Mailing Address - Country:US
Mailing Address - Phone:817-764-3077
Mailing Address - Fax:
Practice Address - Street 1:121 NW ELLISON ST STE 101
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4739
Practice Address - Country:US
Practice Address - Phone:817-764-3077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty