# TETON HEARING CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659523694
- **Authorized official:** ELIZA S. PETERSEN M.A. CCC-A FAAA (MANAGER/MEMBER/AUDIOLOGIST)
- **Authorized official phone:** (208) 569-8787

## Contact information

- **Practice address:** 50 SKI HILL RD., DRIGGS, ID 83422
- **Practice address phone:** (208) 569-8787
- **Practice address fax:** (208) 354-2656
- **Mailing address:** P.O. BOX 692, DRIGGS, ID 83422
- **Mailing address phone:** (208) 569-8787
- **Mailing address fax:** (208) 354-2656

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | A-974 | WY | Yes |
| 231H00000X | Audiologist | AUD1142 | ID | — |
| 237600000X | Audiologist-Hearing Aid Fitter | A-974 | WY | — |
| 237600000X | Audiologist-Hearing Aid Fitter | AUD1142 | ID | — |

## Other

- **Enumeration date:** 10/22/2008
- **Last updated:** 10/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 125563100 | — | WY |
| 05 | — | 807694600 | — | ID |