Provider Demographics
NPI:1841315827
Name:ADVANCED AUDIOLOGY AND HEARING TECHNOLOGY LLC
Entity type:Organization
Organization Name:ADVANCED AUDIOLOGY AND HEARING TECHNOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCCA
Authorized Official - Phone:972-539-7821
Mailing Address - Street 1:2301 OLYMPIA DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1845
Mailing Address - Country:US
Mailing Address - Phone:972-539-7821
Mailing Address - Fax:972-539-7849
Practice Address - Street 1:2301 OLYMPIA DR.
Practice Address - Street 2:SUITE 300
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1845
Practice Address - Country:US
Practice Address - Phone:972-539-7821
Practice Address - Fax:972-539-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50360332S00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty