Provider Demographics
NPI:1871964726
Name:COLORADO HEARING AND BALANCE CLINIC
Entity type:Organization
Organization Name:COLORADO HEARING AND BALANCE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-338-3359
Mailing Address - Street 1:175 S UNION BLVD
Mailing Address - Street 2:330
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3113
Mailing Address - Country:US
Mailing Address - Phone:719-442-6984
Mailing Address - Fax:719-442-6985
Practice Address - Street 1:175 S UNION BLVD
Practice Address - Street 2:330
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3113
Practice Address - Country:US
Practice Address - Phone:719-442-6984
Practice Address - Fax:719-442-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD0000787237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty