Healthcare Provider Details

I. General information

NPI: 1548866262
Provider Name (Legal Business Name): HICKORY AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 S LANDMARK AVE SUITE B
BLOOMINGTON IN
47403
US

IV. Provider business mailing address

533 S LANDMARK AVE SUITE B
BLOOMINGTON IN
47403
US

V. Phone/Fax

Practice location:
  • Phone: 812-202-6168
  • Fax:
Mailing address:
  • Phone: 812-202-6168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIZABETH THOMPSON
Title or Position: OWNER
Credential: AUD
Phone: 630-744-9687