Healthcare Provider Details

I. General information

NPI: 1528225596
Provider Name (Legal Business Name): SYCAMORE HEARING AID CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 BETHANY RD SUITE 100
SYCAMORE IL
60178-3126
US

IV. Provider business mailing address

2535 BETHANY ROAD SUITE 100
SYCAMORE IL
60178
US

V. Phone/Fax

Practice location:
  • Phone: 815-787-4327
  • Fax:
Mailing address:
  • Phone: 815-787-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number147-000688
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number147-000688
License Number StateIL

VIII. Authorized Official

Name: MRS. SANDRA BROADDUS
Title or Position: OWNER
Credential: M S CCC A
Phone: 815-787-4237