Healthcare Provider Details

I. General information

NPI: 1750572608
Provider Name (Legal Business Name): HENDRICKSON HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 E CATCLAW ST
GILBERT AZ
85296-3376
US

IV. Provider business mailing address

2107 E CATCLAW ST
GILBERT AZ
85296-3376
US

V. Phone/Fax

Practice location:
  • Phone: 480-735-9234
  • Fax:
Mailing address:
  • Phone: 480-735-9234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD2033
License Number StateAZ

VIII. Authorized Official

Name: MR. WADE HENDRICKSON
Title or Position: PRESIDENT
Credential: BC-HIS
Phone: 480-735-9234