Basic Information
Provider Information | |||||||||
NPI: | 1619405503 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SEEL | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | SCOTT | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | H.I.S. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1802 GALLOWAY ST | ||||||||
Address2: |   | ||||||||
City: | EAU CLAIRE | ||||||||
State: | WI | ||||||||
PostalCode: | 547033467 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7158318966 | ||||||||
FaxNumber: | 7158318968 | ||||||||
Practice Location | |||||||||
Address1: | 1927 N MITCHELL ST | ||||||||
Address2: |   | ||||||||
City: | CADILLAC | ||||||||
State: | MI | ||||||||
PostalCode: | 496011139 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2317790585 | ||||||||
FaxNumber: | 2317798565 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/23/2017 | ||||||||
LastUpdateDate: | 06/16/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 3501009077 | MI | Y |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 3501009077 | 01 | MI | 3501009077 | OTHER |