Provider Demographics
NPI:1417977026
Name:HIGHLAND LAKES AUDIOLOGY
Entity type:Organization
Organization Name:HIGHLAND LAKES AUDIOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:830-693-1251
Mailing Address - Street 1:304B GATEWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-6322
Mailing Address - Country:US
Mailing Address - Phone:830-693-1251
Mailing Address - Fax:830-693-8476
Practice Address - Street 1:304B GATEWAY LOOP
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-6322
Practice Address - Country:US
Practice Address - Phone:830-693-1251
Practice Address - Fax:830-693-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50252231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00732VMedicare ID - Type UnspecifiedHIGHLAND LAKES AUDIOLOGY
TX8B1347Medicare ID - Type UnspecifiedANGELA WOOTEN