Healthcare Provider Details

I. General information

NPI: 1952563504
Provider Name (Legal Business Name): AUDIOLOGY H.E.A.R., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 BLACKBERRY DR UNIT 204
GENEVA IL
60134-1084
US

IV. Provider business mailing address

2172 BLACKBERRY DR UNIT 204
GENEVA IL
60134-1084
US

V. Phone/Fax

Practice location:
  • Phone: 630-200-9787
  • Fax: 630-262-0397
Mailing address:
  • Phone: 630-200-9787
  • Fax: 630-262-0397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number147.001259
License Number StateIL

VIII. Authorized Official

Name: DR. KYLE RICHARD RATERMAN
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 630-200-9787