Healthcare Provider Details

I. General information

NPI: 1356294284
Provider Name (Legal Business Name): CENTRAL ILLINOIS AUDIOLOGY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WESTGATE DR
SPRINGFIELD IL
62711-7434
US

IV. Provider business mailing address

4000 WESTGATE DR
SPRINGFIELD IL
62711-7434
US

V. Phone/Fax

Practice location:
  • Phone: 217-726-6101
  • Fax:
Mailing address:
  • Phone: 217-726-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER C EDMONDS
Title or Position: OWNER
Credential: AUD
Phone: 217-726-6101