Healthcare Provider Details

I. General information

NPI: 1649612649
Provider Name (Legal Business Name): HEARING REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 17TH AVE UNIT H
LONGMONT CO
80501-9747
US

IV. Provider business mailing address

8321 SANGRE DE CRISTO RD STE 202
LITTLETON CO
80127-6425
US

V. Phone/Fax

Practice location:
  • Phone: 303-485-9720
  • Fax: 303-485-9735
Mailing address:
  • Phone: 303-984-4414
  • Fax: 303-984-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateCO

VIII. Authorized Official

Name: MATTHEW A WILKEN
Title or Position: VICE PRESIDENT
Credential: AUD
Phone: 303-984-4414