SAN DIEGO STATE UNIVERSITY (NPI# 1972964468) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972964468 |
| Entity Type | Organization |
| Organization Name | SAN DIEGO STATE UNIVERSITY |
| Other Organization Name | SAN DIEGO STATE UNIVERSITY SPEECH, LANGUAGE AND HEARING CLINIC |
| Practice Address |
5500 Campanile Dr San Diego CA 92182-1518 |
| Practice Telephone | 6195947747 |
| Practice Fax Number | 6195945917 |
| Mailing Telephone | 6195947747 |
| Mailing Fax Number | 6195945917 |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2016-03-11 |
| Authorized Official Name | AGNES WONG NICKERSON (ASSOCIATE VP OF FINANCIAL OPERATION) |
| Authorized Official Telephone | 6195946017 |
| Is Organization Subpart | Y |
| Parent Organization Name | SAN DIEGO STATE UNIVERSITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| Y | 237600000X | Audiologist-Hearing Aid Fitter | Speech, Language and Hearing Service Providers |
| Other Name | Type Code |
|---|---|
| San Diego State University Speech, Language and Hearing Clinic | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649380726 | San Diego State University | Clinical Medical Laboratory | 5500 Campanile Dr, San Diego, CA 92182-4701 | 2006-08-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SAN DIEGO STATE UNIVERSITY | 5500 Campanile Dr, San Diego, CA 92182-0001 |
| System for Award Management (SAM) Entities | SAN DIEGO STATE UNIVERSITY RESEARCH FOUNDATION | 5250 Campanile Dr Mc1947, San Diego, CA 92182-1901 |
| Street Address |
5500 CAMPANILE DR |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92182-1518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649206269 | Denise Ann Wiksten | Specialist/Technologist | 5500 Campanile Dr, Dept. of Exercise & Nutritional Sciences, San Diego, CA 92182-0001 | 2006-06-24 |
| 1326663840 | Lisa Marie Contois | Specialist/Technologist | 5500 Campanile Dr, San Diego, CA 92182-0001 | 2020-06-10 |
| 1013547058 | Samantha Queen | Specialist/Technologist | 5500 Campanile Dr, San Diego, CA 92182-0001 | 2020-01-17 |
| 1134777246 | Sara Alyson Leighanne Self | Specialist/Technologist | 5500 Campanile Dr, San Diego, CA 92182-1680 | 2019-09-01 |
| 1033767793 | Eric Estrada | Student in an Organized Health Care Education/Training Program | 5500 Campanile Dr, San Diego, CA 92182-0001 | 2019-08-27 |
| 1376009506 | Kyle Nicholas Llorens | Physical Therapist | 5500 Campanile Dr, San Diego, CA 92182-0001 | 2019-02-12 |
| 1336604990 | Alaina Katherine Nicholas | Student in an Organized Health Care Education/Training Program | 5500 Campanile Dr, San Diego, CA 92182-0001 | 2019-02-07 |
| 1518431972 | Nathaniel Burns Bechtel | Student in an Organized Health Care Education/Training Program | 5500 Campanile Dr, San Diego, CA 92182-0003 | 2019-01-17 |
| 1205325065 | Queenie Soriano | Specialist/Technologist | 5500 Campanile Dr, San Diego, CA 92182-0001 | 2018-05-08 |
| 1558850370 | Kristin Anne Manyak | Specialist/Technologist | 5500 Campanile Dr, San Diego, CA 92182-0001 | 2018-05-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184137861 | Megan Lawler | Specialist/Technologist | 5032 55th Street, San Diego, CA 92182 | 2017-11-16 |
| 1548501703 | Jon Eric Alexander | Counselor | 5500 Campanile Dr., San Diego, CA 92182 | 2013-03-12 |
| 1114575875 | Rand Al Urfali | Student in an Organized Health Care Education/Training Program | 5500 Campanile Drive, San Diego, CA 92182 | 2019-08-27 |
| 1326414988 | Rachel Mahoney | Counselor | 5500 Campanile Drive, San Diego, CA 92182 | 2015-08-18 |
| 1215551551 | Jacob Riley Callahan | Specialist/Technologist | 5302 55th St, San Diego, CA 92182-0001 | 2020-06-02 |
| 1164573234 | Amol Narendra Doshi | Preventive Medicine | Sdsu Calpulli Ctr Health Svcs 5500 Campanile Dr, San Diego, CA 92182-0001 | 2007-01-16 |
| 1710973953 | Cathy Ann Baughman-gross | Nurse Practitioner | 7500 Hardy Ave, San Diego, CA 92182-0001 | 2005-09-22 |
| 1972531994 | Donald Fredrick Kessler | Specialist/Technologist | 5500 Campanille Dr, San Diego, CA 92182-4313 | 2006-06-29 |
| 1033184064 | Carolyn Rae Peters | Specialist/Technologist | 5505 Campanile Dr., Aac 1402, San Diego, CA 92182-4313 | 2006-02-22 |
| 1902443518 | Sergio Miguel Ibarra | Specialist/Technologist | 5500 Campanile Drive, San Diego, CA 92182-4313 | 2019-12-02 |
| Find all providers in zip 92182 | ||||
| Taxonomy Code | 237600000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Audiologist-Hearing Aid Fitter |
| An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of tests to determine the exact nature of an individual’s hearing problem, presents a variety of treatment options to patients, dispenses and fits hearing aids, administers tests of balance to evaluate dizziness and provides hearing rehabilitation training. This classification should be used where individuals are licensed as "audiologist-hearing aid fitters" as opposed to states that license individuals as "audiologists". |
| Notes: Source: American Academy of Audiology, 1735 N. Lynn St, Suite 950, Arlington VA 22209, (800)AAA-2336) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306276886 | Northland Hearing Centers, Inc | Audiologist-Hearing Aid Fitter | 4504 Clairemont Mesa Blvd, San Diego, CA 92117-2065 | 2013-11-19 |
| 1619282696 | Kenneth A Podlenski, Aud, An Audiology Corporation | Audiologist-Hearing Aid Fitter | 12396 World Trade Dr Ste 205, San Diego, CA 92128-3788 | 2010-08-13 |
| 1053419309 | Sonus-usa, Inc. | Audiologist-Hearing Aid Fitter | 9340 Clairemont Mesa Blvd, San Diego, CA 92123-1224 | 2006-09-20 |
| 1609814086 | Antonio C Lacarra | Audiologist-Hearing Aid Fitter | 1244 University Ave, San Diego, CA 92103-3312 | 2006-06-04 |
| 1497279657 | Kristen Baisley | Audiologist-Hearing Aid Fitter | 3020 Children's Way, Mc 5010, San Diego, CA 92123 | 2017-07-31 |
| 1700300308 | Michelle Hu | Audiologist-Hearing Aid Fitter | 3665 Kearny Villa Rd Ste 400, San Diego, CA 92123-1955 | 2017-07-26 |
| 1215487806 | San Diego Hearing Center, Inc. | Audiologist-Hearing Aid Fitter | 4282 Genesee Ave Ste 301, San Diego, CA 92117-4998 | 2016-10-07 |
| 1427458884 | Colleen Moore | Audiologist-Hearing Aid Fitter | 6727 Flanders Dr, #204, San Diego, CA 92121-2926 | 2014-09-03 |
| 1366791691 | Kathleen Alysia Grichar | Audiologist-Hearing Aid Fitter | 4282 Genesee Ave, Suite 301, San Diego, CA 92117-4946 | 2012-08-31 |
| 1093091662 | American Hearing Aid Center of The South Bay Inc | Audiologist-Hearing Aid Fitter | 9340 Clairemont Mesa Blvd, Ste D, San Diego, CA 92123-1224 | 2011-10-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.