Provider Demographics
NPI:1144536806
Name:ANDERSON AUDIOLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:ANDERSON AUDIOLOGY ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-282-8402
Mailing Address - Street 1:PO BOX 1258
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-1258
Mailing Address - Country:US
Mailing Address - Phone:817-282-8402
Mailing Address - Fax:817-285-6182
Practice Address - Street 1:1550 NORWOOD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3646
Practice Address - Country:US
Practice Address - Phone:817-282-8402
Practice Address - Fax:817-285-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50913231HA2400X, 237600000X, 237700000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty