Forest Lake Audiology LLC

Primary specialty

AudiologistTaxonomy code 231H00000X

License

SC3435 Issued in SC

Legal business name

FOREST LAKE AUDIOLOGY LLC

Practice address

5301 N Trenholm Rd
Suite a
Columbia, SC 29206-3226

Phone

(803) 888-7330

NPI assigned

Jan 5, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Todd Gibson, AUDIOLOGIST

Title

Owner

Phone

(803) 888-7330

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458086400000",
    "number": "1407212525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 N TRENHOLM RD",
            "address_2": "SUITE A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292063226",
            "telephone_number": "803-888-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 N TRENHOLM RD",
            "address_2": "SUITE A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292063226",
            "telephone_number": "803-888-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST LAKE AUDIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-05",
        "last_updated": "2016-03-16",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-888-7330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "AUDIOLOGIST"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Audiologist",
            "state": "SC",
            "license": "SC3435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Audiologist in Columbia, SC
• Providers in Columbia, SC by specialty
• Audiologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.