Provider Demographics
NPI:1588922314
Name:SOUTHERN NEVADA AUDIOLOGY
Entity type:Organization
Organization Name:SOUTHERN NEVADA AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PAGE-UNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:702-990-1568
Mailing Address - Street 1:6061 S. FORT APACHE #130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5578
Mailing Address - Country:US
Mailing Address - Phone:703-990-1568
Mailing Address - Fax:702-943-1408
Practice Address - Street 1:6061 S. FORT APACHE #130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5578
Practice Address - Country:US
Practice Address - Phone:703-990-1568
Practice Address - Fax:702-943-1408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN NEVADA AUDIOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty