Provider Demographics
NPI:1306468806
Name:WALA-AU THERAPY LLC
Entity type:Organization
Organization Name:WALA-AU THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:808-365-8128
Mailing Address - Street 1:2148 AWAPUHI STREET
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5290
Mailing Address - Country:US
Mailing Address - Phone:808-365-8128
Mailing Address - Fax:808-961-6383
Practice Address - Street 1:2148 AWAPUHI STREET
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5290
Practice Address - Country:US
Practice Address - Phone:808-365-8128
Practice Address - Fax:808-961-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000133Medicaid