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Organization
TETON HEARING CENTER LLC
Active
Organization
TETON HEARING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZA S. PETERSEN M.A. CCC-A FAAA (MANAGER/MEMBER/AUDIOLOGIST)
(208) 569-8787
Entity
Organization
Contact information
Practice address
50 SKI HILL RD., DRIGGS, ID 83422
(208) 569-8787
(208) 354-2656
Mailing address
P.O. BOX 692, DRIGGS, ID 83422
(208) 569-8787
(208) 354-2656
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
A-974
WY
231H00000X
Audiologist
AUD1142
ID
237600000X
Audiologist-Hearing Aid Fitter
A-974
WY
237600000X
Audiologist-Hearing Aid Fitter
AUD1142
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125563100
—
WY
05
—
807694600
—
ID
Enumeration date
10/22/2008
Last updated
10/22/2008
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