| Name | Value |
|---|---|
| PROVIDER TYPE | Speech, Language and Hearing Service Providers |
| CLASSIFICATION | Audiologist |
| AREA OF SPECIALIZATION | Assistive Technology Practitioner |
| STATUS | Active |
| VA CODE | V140101 |
| X12 CODE | 231HA2400X |
| SPECIALTY CODE | 64 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255438 |
| EFFECTIVE DATE/TIME |
|