Healthcare Provider Details

I. General information

NPI: 1013958941
Provider Name (Legal Business Name): PATTI L ALLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N KNOXVILLE AVE SUITE 116
PEORIA IL
61614-5098
US

IV. Provider business mailing address

5401 N KNOXVILLE AVE SUITE 116
PEORIA IL
61614-5021
US

V. Phone/Fax

Practice location:
  • Phone: 309-282-0887
  • Fax: 309-282-0947
Mailing address:
  • Phone: 309-282-0887
  • Fax: 309-282-0947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateIL

VIII. Authorized Official

Name: PATTI LYNN ALLY
Title or Position: AUDIOLOGIST OWNER
Credential: M.S.
Phone: 309-282-0887