Basic Information
Provider Information
NPI: 1538417043
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AHERN
FirstName: RICHARD
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: H.I.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26222 RR 12
Address2:  
City: DRIPPING SPRINGS
State: TX
PostalCode: 786204903
CountryCode: US
TelephoneNumber: 5128580300
FaxNumber: 5128582714
Practice Location
Address1: 1204 N LLANO ST STE A
Address2:  
City: FREDERICKSBURG
State: TX
PostalCode: 786243560
CountryCode: US
TelephoneNumber: 8309904004
FaxNumber: 8309901016
Other Information
ProviderEnumerationDate: 08/15/2012
LastUpdateDate: 08/15/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237600000X80547TXY Speech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter 

No ID Information.


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