Provider Demographics
NPI:1841508173
Name:AUDIOLOGY CONSULTANTS OF SOUTHWEST FLORIDA
Entity type:Organization
Organization Name:AUDIOLOGY CONSULTANTS OF SOUTHWEST FLORIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JACK (JOHN)
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHIPPENDALE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-A
Authorized Official - Phone:239-481-2088
Mailing Address - Street 1:15721 NEW HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-481-2088
Mailing Address - Fax:239-481-2095
Practice Address - Street 1:15721 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-481-2088
Practice Address - Fax:239-481-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY274231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S0637OtherBLUE CROSS BLUE SHIELD