Healthcare Provider Details

I. General information

NPI: 1992272553
Provider Name (Legal Business Name): INNOVATIVE HEARING SOLUTIONS OF INDIANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 PARK EAST BLVD STE 3
LAFAYETTE IN
47905-0788
US

IV. Provider business mailing address

480 W NAVAJO ST STE A
WEST LAFAYETTE IN
47906-1940
US

V. Phone/Fax

Practice location:
  • Phone: 765-771-7109
  • Fax: 765-770-8668
Mailing address:
  • Phone: 765-771-7109
  • Fax: 765-770-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MRS. MOLLY ELIZABETH HERENDEEN
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 765-771-7109