Provider Demographics
NPI:1710196027
Name:CAROLYN WYATT AUDIOLOGY SERVICES INC
Entity type:Organization
Organization Name:CAROLYN WYATT AUDIOLOGY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-656-1933
Mailing Address - Street 1:8218 WISCONSIN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3107
Mailing Address - Country:US
Mailing Address - Phone:301-656-1933
Mailing Address - Fax:301-656-0881
Practice Address - Street 1:8218 WISCONSIN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:301-656-1933
Practice Address - Fax:301-656-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490028Medicare UPIN