Healthcare Provider Details

I. General information

NPI: 1932473345
Provider Name (Legal Business Name): AUDIOLOGY INNOVATIONS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 12/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 S ELDORADO RD STE 1
BLOOMINGTON IL
61704-6035
US

IV. Provider business mailing address

816 S ELDORADO RD STE 1
BLOOMINGTON IL
61704-6035
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-8346
  • Fax: 309-662-0479
Mailing address:
  • Phone: 309-662-8346
  • Fax: 309-662-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-001154
License Number StateIL

VIII. Authorized Official

Name: DR. NATALIE MAE MCKEE
Title or Position: DOCTOR OF AUDIOLOGY
Credential: AU.D.
Phone: 815-751-6691