Provider Demographics
NPI:1972774461
Name:MARY CRITCHLEY AUDIOLOGIST, INC
Entity type:Organization
Organization Name:MARY CRITCHLEY AUDIOLOGIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRITCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:714-776-8757
Mailing Address - Street 1:720 S EUCLID ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1530
Mailing Address - Country:US
Mailing Address - Phone:714-776-8757
Mailing Address - Fax:714-776-8758
Practice Address - Street 1:720 S EUCLID ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1530
Practice Address - Country:US
Practice Address - Phone:714-776-8757
Practice Address - Fax:714-776-8758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1754237600000X
CAHA3751332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty