Healthcare Provider Details

I. General information

NPI: 1205178910
Provider Name (Legal Business Name): PROFESSIONAL HEARING SOLUTIONS OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 09/18/2021
Certification Date: 09/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8806 COLDWATER RD
FORT WAYNE IN
46825-2715
US

IV. Provider business mailing address

8806 COLDWATER RD
FORT WAYNE IN
46825-2715
US

V. Phone/Fax

Practice location:
  • Phone: 260-482-4327
  • Fax: 260-482-4320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002271A
License Number StateIN

VIII. Authorized Official

Name: LISA GREENWAY
Title or Position: OWNER
Credential: AU.D.
Phone: 260-482-4327