Healthcare Provider Details

I. General information

NPI: 1205245719
Provider Name (Legal Business Name): DEANNA MARIE GINDER-WEST M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 EASTLAND DR STE F
BLOOMINGTON IL
61704-3510
US

IV. Provider business mailing address

2101 EASTLAND DR STE F
BLOOMINGTON IL
61704-3510
US

V. Phone/Fax

Practice location:
  • Phone: 309-664-6200
  • Fax:
Mailing address:
  • Phone: 309-664-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.000838
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: