Healthcare Provider Details

I. General information

NPI: 1235392614
Provider Name (Legal Business Name): KAREN R GLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5063 SHORELINE RD
LAKE BARRINGTON IL
60010-1700
US

IV. Provider business mailing address

5063 SHORELINE RD
LAKE BARRINGTON IL
60010-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-382-6010
  • Fax: 847-382-9243
Mailing address:
  • Phone: 847-382-6010
  • Fax: 847-382-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147000363
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number147000363
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number147000363
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147000363
License Number StateIL

VIII. Authorized Official

Name: KAREN RYNISH GLAY
Title or Position: AUDIOLOGIST/OWNER
Credential: M.A.
Phone: 847-382-6010