Organization
LAKESIDE AUDIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY BLOCK AUD (DOCTOR OF AUDIOLOGY)
(803) 412-6789
Entity
Organization
Contact information
Practice address
870 GOLD HILL RD STE 104, FORT MILL, SC 29708-8988
(803) 620-8250
(803) 638-6901
Mailing address
870 GOLD HILL RD STE 104, FORT MILL, SC 29708-8988
(803) 620-8250
(803) 638-6901
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QH0700X
Hearing and Speech Clinic/Center
Primary
4011
SC
261QH0700X
Hearing and Speech Clinic/Center
9758
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA1525
—
SC
Enumeration date
03/19/2015
Last updated
11/19/2021
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