Healthcare Provider Details

I. General information

NPI: 1366824005
Provider Name (Legal Business Name): DEKALB HEARING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 GATEWAY DRIVE
SYCAMORE IL
60178
US

IV. Provider business mailing address

2240 GATEWAY DR
SYCAMORE IL
60178-3103
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-8571
  • Fax: 815-756-5603
Mailing address:
  • Phone: 815-756-8571
  • Fax: 815-756-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 469-214-0144