Healthcare Provider Details

I. General information

NPI: 1679708929
Provider Name (Legal Business Name): CENTRAL ILLINOIS HEARING & SPEECH LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WESTGATE DR
SPRINGFIELD IL
62711-7066
US

IV. Provider business mailing address

4000 WESTGATE DR
SPRINGFIELD IL
62711-7066
US

V. Phone/Fax

Practice location:
  • Phone: 217-726-6101
  • Fax: 217-726-6103
Mailing address:
  • Phone: 217-726-6101
  • Fax: 217-726-6103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147000273
License Number StateIL

VIII. Authorized Official

Name: DAVID M. GROESCH
Title or Position: OWNER
Credential: AUD
Phone: 217-726-6101