Provider Demographics
NPI:1154912210
Name:BASS, WILLIAM A (HAD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:BASS
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 E SANGER ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-4504
Mailing Address - Country:US
Mailing Address - Phone:575-393-3056
Mailing Address - Fax:575-391-7899
Practice Address - Street 1:812 E SANGER ST STE B
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-4504
Practice Address - Country:US
Practice Address - Phone:575-393-3056
Practice Address - Fax:575-391-7899
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMHAD770237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist