Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1083750996 Individual Practitioner Female Practitioner

Dr. Eliza S. Petersen , AuD, CCCA

Audiologist • Driggs, ID

Professional Overview & Biography Verified Profile Summary

Dr. Eliza Petersen, AuD, CCCA is a registered healthcare professional specializing in Audiologist in Driggs, ID. Practice services are available at 2740 SHADOWMOON LN STE 417 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

2740 Shadowmoon Ln Ste 417

Driggs, ID 834225083

Telephone 3077455587
Fax 8775151633

Specialty Benchmarks & Practice Insights

Comparative analytics for Audiologist in Driggs, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 14.8 Yrs
Regional Practice Density
1 Specialists

Practicing in Driggs, ID (124 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-04-19
Audiologist Primary Specialty

NUCC Taxonomy Code: 231H00000X

State License ID AUD-1142

(1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function. Audiologists are autonomous professionals who identify, assess, and manage disorders of the auditory, balance and other neural systems. Audiologists provide audiological (aural) rehabilitation to children and adults across the entire age span. Audiologists select, fit and dispense amplification systems such as hearing aids and related devices. (2) An audiologist is a person qualified by a master's degree in audiology, licensed by the state, where applicable, and practicing within the scope of that license. Audiologists evaluate and treat patients with impaired hearing. They plan, direct and conduct rehabilitative programs with audiotry substitutional devises (hearing aids) and other therapy.

Audiologist

NUCC Taxonomy Code: 231H00000X

State License WY A-974

(1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function. Audiologists are autonomous professionals who identify, assess, and manage disorders of the auditory, balance and other neural systems. Audiologists provide audiological (aural) rehabilitation to children and adults across the entire age span. Audiologists select, fit and dispense amplification systems such as hearing aids and related devices. (2) An audiologist is a person qualified by a master's degree in audiology, licensed by the state, where applicable, and practicing within the scope of that license. Audiologists evaluate and treat patients with impaired hearing. They plan, direct and conduct rehabilitative programs with audiotry substitutional devises (hearing aids) and other therapy.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
807694600 (ID)
Medicaid State Provider ID
125563100 (WY)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
📍
Updated Practice Location April 19, 2023

Registered at 2740 SHADOWMOON LN STE 417, DRIGGS, ID 834225083 (Tel: 3077455587)

📍
Updated Business Mailing Address April 19, 2023

Registered at 1388 MOUNT MORIAH RD, LIVERMORE, CO 805369311 (Tel: 3077455587)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 19, 2023

Audiologist (License #A-974 in WY)

📍
Updated Practice Location December 01, 2020

Registered at 2299 TALON CIR, DRIGGS, ID 834224911 (Tel: 3077455587)

📍
Updated Business Mailing Address December 01, 2020

Registered at 2299 TALON CIR, DRIGGS, ID 834224911 (Tel: 3077455587)

👤
Provider Name / Credentials Updated December 01, 2020

Recorded as ELIZA PETERSEN, AUD, CCCA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 01, 2020

Audiologist (License #AUD-1142 in ID)

NPI Profile Active July 03, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location July 03, 2014

Registered at 555 E BROADWAY STE. 224, BOX 428, JACKSON, WY 830010428 (Tel: 3077339141)

📍
Updated Business Mailing Address July 03, 2014

Registered at PO BOX 428, 555 E BROADWAY STE. 224, JACKSON, WY 830010428 (Tel: 3077339141)

👤
Provider Name / Credentials Updated July 03, 2014

Recorded as ELIZA PETERSEN, M.A., CCCA, FAAA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 03, 2014

Audiologist (License #A-974 in WY)

🟢
Initial NPI Registration & Enumeration January 29, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1083750996
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 29, 2007
Last Update: April 19, 2023
Sole Proprietor: Yes

Mailing Address

1388 Mount Moriah Rd

Livermore, CO 805369311

Phone: 3077455587

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.