Healthcare Provider Details

I. General information

NPI: 1477075950
Provider Name (Legal Business Name): BENJAMIN L HENDRICKS AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 11/10/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 CLIFTY DR
MADISON IN
47250-1608
US

IV. Provider business mailing address

529 CLIFTY DR
MADISON IN
47250-1608
US

V. Phone/Fax

Practice location:
  • Phone: 812-273-6262
  • Fax: 812-273-1915
Mailing address:
  • Phone: 812-273-6262
  • Fax: 812-273-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number23002629A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number23002629A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number23002629A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002629A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: