Healthcare Provider Details

I. General information

NPI: 1871705798
Provider Name (Legal Business Name): SUSAN ROGAN HEARING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 OGDEN AVE
DOWNERS GROVE IL
60515-2742
US

IV. Provider business mailing address

1501 OGDEN AVE
DOWNERS GROVE IL
60515-2742
US

V. Phone/Fax

Practice location:
  • Phone: 630-969-1677
  • Fax: 630-969-4384
Mailing address:
  • Phone: 630-969-1677
  • Fax: 630-969-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147000150
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147000150
License Number StateIL

VIII. Authorized Official

Name: MRS. SUSAN D MENOZI
Title or Position: AUDIOLOGIST
Credential: AUD
Phone: 630-969-1677