Basic Information
Provider Information
NPI: 1376051565
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REMEYER
FirstName: COLLEEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
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OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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Mailing Information
Address1: 215 SHUMAN BLVD STE 401
Address2:  
City: NAPERVILLE
State: IL
PostalCode: 605638123
CountryCode: US
TelephoneNumber: 6303035380
FaxNumber: 6303035385
Practice Location
Address1: 30250 RANCHO VIEJO RD STE A
Address2:  
City: SAN JUAN CAPISTRANO
State: CA
PostalCode: 926751555
CountryCode: US
TelephoneNumber: 9494890668
FaxNumber: 9494891475
Other Information
ProviderEnumerationDate: 01/22/2018
LastUpdateDate: 03/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/25/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237700000XHA8176CAY Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


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