Healthcare Provider Details

I. General information

NPI: 1932929452
Provider Name (Legal Business Name): DYNAMIC HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 WARREN AVE STE 200
DOWNERS GROVE IL
60515-3572
US

IV. Provider business mailing address

1121 WARREN AVE STE 200
DOWNERS GROVE IL
60515-3572
US

V. Phone/Fax

Practice location:
  • Phone: 773-406-1070
  • Fax:
Mailing address:
  • Phone: 773-406-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LANDELL L SMITH
Title or Position: OWNER
Credential: H.I.S.
Phone: 773-406-1070