Basic Information
Provider Information
NPI: 1386114759
EntityType: 2
ReplacementNPI:  
OrganizationName: FREEDOM AUDIOLOGY, PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FREEDOM AUDIOLOGY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
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Mailing Information
Address1: 15655 W ROOSEVELT ST STE 216
Address2:  
City: GOODYEAR
State: AZ
PostalCode: 853389342
CountryCode: US
TelephoneNumber: 6236965817
FaxNumber: 6233218009
Practice Location
Address1: 15655 W ROOSEVELT ST STE 216
Address2:  
City: GOODYEAR
State: AZ
PostalCode: 853389342
CountryCode: US
TelephoneNumber: 6236965817
FaxNumber: 6233218009
Other Information
ProviderEnumerationDate: 11/28/2018
LastUpdateDate: 11/28/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CORDERY
AuthorizedOfficialFirstName: COLLIN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER / AUDIOLOGIST
AuthorizedOfficialTelephone: 6236965817
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: AU.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QH0700X  N Ambulatory Health Care FacilitiesClinic/CenterHearing and Speech
231H00000X  Y193200000X MULTI-SPECIALTY GROUPSpeech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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