Healthcare Provider Details

I. General information

NPI: 1477993707
Provider Name (Legal Business Name): JANNA LEE WEBER AU D, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANNA LEE SORENSEN AU D, CCC-A

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WALDRON ST
HUTCHINSON KS
67502-1131
US

IV. Provider business mailing address

2101 N WALDRON ST
HUTCHINSON KS
67502-1131
US

V. Phone/Fax

Practice location:
  • Phone: 620-669-2500
  • Fax: 620-694-2128
Mailing address:
  • Phone: 620-669-2500
  • Fax: 620-694-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2241
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2241
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: