Healthcare Provider Details

I. General information

NPI: 1992086623
Provider Name (Legal Business Name): LINDA RENEE HEROUT AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4614 S 132ND ST
OMAHA NE
68137-1764
US

IV. Provider business mailing address

933 E PIERCE ST STE 310
COUNCIL BLUFFS IA
51503-4626
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-3211
  • Fax: 402-330-5970
Mailing address:
  • Phone: 712-396-4300
  • Fax: 707-570-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD635
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAUD635
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number326
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: