Provider Demographics
NPI:1962600536
Name:AUDIOLOGY OF KENTUCKIANA, INC
Entity type:Organization
Organization Name:AUDIOLOGY OF KENTUCKIANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:270-926-0418
Mailing Address - Street 1:920 FREDERICA ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3050
Mailing Address - Country:US
Mailing Address - Phone:270-926-0418
Mailing Address - Fax:270-686-8928
Practice Address - Street 1:920 FREDERICA ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3050
Practice Address - Country:US
Practice Address - Phone:270-926-0418
Practice Address - Fax:270-686-8928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0486174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2305Medicare ID - Type Unspecified