Healthcare Provider Details

I. General information

NPI: 1073148417
Provider Name (Legal Business Name): HEAR FOR YOU AUDIOLOGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 CLYDE MORRIS BLVD STE B
PORT ORANGE FL
32129-4080
US

IV. Provider business mailing address

4550 CLYDE MORRIS BLVD STE B
PORT ORANGE FL
32129-4080
US

V. Phone/Fax

Practice location:
  • Phone: 386-265-4769
  • Fax: 386-265-4618
Mailing address:
  • Phone: 386-265-4769
  • Fax: 386-265-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: DR. DANA JICKELL
Title or Position: OWNER/AUDIOLOGIST
Credential: AUD
Phone: 863-265-4769