Provider Demographics
NPI:1215104153
Name:CHAMPLAIN VALLEY AUDIOLOGY, PLLC
Entity type:Organization
Organization Name:CHAMPLAIN VALLEY AUDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MACNER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:518-324-5707
Mailing Address - Street 1:176 US OVAL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-3900
Mailing Address - Country:US
Mailing Address - Phone:518-324-5707
Mailing Address - Fax:518-324-5726
Practice Address - Street 1:176 US OVAL
Practice Address - Street 2:SUITE 3
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-3900
Practice Address - Country:US
Practice Address - Phone:518-324-5707
Practice Address - Fax:518-324-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000001179237600000X
NY1424231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty