Healthcare Provider Details

I. General information

NPI: 1720515240
Provider Name (Legal Business Name): SCOTT SUMRALL AU.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21124 WASHINGTON PKWY
FRANKFORT IL
60423-3112
US

IV. Provider business mailing address

21124 WASHINGTON PKWY
FRANKFORT IL
60423-3112
US

V. Phone/Fax

Practice location:
  • Phone: 815-239-0673
  • Fax: 775-336-0213
Mailing address:
  • Phone: 152-390-6738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number187.001812
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001812
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: