Basic Information
| Provider Information | |||||||||
| NPI: | 1629220371 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARING CHOICES DBA JEFFERSON HEARING AID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 391 QUADRANGLE DR | ||||||||
| Address2: | SUITE S-1 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604403442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302260327 | ||||||||
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| Practice Location | |||||||||
| Address1: | 391 QUADRANGLE DR | ||||||||
| Address2: | SUITE S-1 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604403442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302260327 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2008 | ||||||||
| LastUpdateDate: | 10/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | KOVACIK | ||||||||
| AuthorizedOfficialFirstName: | DAWN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 6302260327 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.A. CCC-A | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 147001095 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 147000011 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.