Healthcare Provider Details

I. General information

NPI: 1336592039
Provider Name (Legal Business Name): HEARING CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 W STATE ST
BOISE ID
83703-4438
US

IV. Provider business mailing address

4121 W STATE ST
BOISE ID
83703-4438
US

V. Phone/Fax

Practice location:
  • Phone: 208-853-2650
  • Fax:
Mailing address:
  • Phone: 208-853-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA-1961
License Number StateID

VIII. Authorized Official

Name: JESSE ALDOUS
Title or Position: OWNER/PROVIDER
Credential:
Phone: 208-853-2650