Provider Demographics
NPI:1306595715
Name:TAHOE FAMILY HEARING CLINIC, PC
Entity type:Organization
Organization Name:TAHOE FAMILY HEARING CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:530-318-4010
Mailing Address - Street 1:1285 APACHE AVE # 306
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96155-7672
Mailing Address - Country:US
Mailing Address - Phone:530-318-4010
Mailing Address - Fax:
Practice Address - Street 1:2074 LAKE TAHOE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6407
Practice Address - Country:US
Practice Address - Phone:530-318-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty