Healthcare Provider Details

I. General information

NPI: 1801000658
Provider Name (Legal Business Name): TRI-COUNTY HEARING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4237 W 95TH ST
OAK LAWN IL
60453-2623
US

IV. Provider business mailing address

140 CORPORATE DR. SUITE 1
BEAVER DAM WI
53916
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-7500
  • Fax: 708-636-7652
Mailing address:
  • Phone: 920-887-2822
  • Fax: 920-887-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2676
License Number StateIL

VIII. Authorized Official

Name: JACLYN SULLIVAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-636-7500