Basic Information
| Provider Information | |||||||||
| NPI: | 1538350491 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWS | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | H.I.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2605 N WATER ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625264269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178755555 | ||||||||
| FaxNumber: | 2178759640 | ||||||||
| Practice Location | |||||||||
| Address1: | 2605 N WATER ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625264269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178755555 | ||||||||
| FaxNumber: | 2178759640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 1710 | IL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.