Basic Information
| Provider Information | |||||||||
| NPI: | 1528271582 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LESTER AND ROSALIE ANIXTER CENTER | ||||||||
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| OtherOrganizationName: | CHICAGO HEARING SOCIETY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6610 N CLARK ST | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606264062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737611501 | ||||||||
| FaxNumber: | 7739771240 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 N CLYBOURN AVE | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606144036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737611501 | ||||||||
| FaxNumber: | 7739771240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 05/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | DESMOND | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7737611501 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 237600000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.