Healthcare Provider Details

I. General information

NPI: 1114036837
Provider Name (Legal Business Name): WILLIAMSPORT HEARING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 W SOUTHERN AVE
SOUTH WILLIAMSPORT PA
17702-7142
US

IV. Provider business mailing address

1215 W SOUTHERN AVE
SOUTH WILLIAMSPORT PA
17702-7142
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-7000
  • Fax: 570-329-1055
Mailing address:
  • Phone: 570-323-7000
  • Fax: 570-329-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT000678L
License Number StatePA

VIII. Authorized Official

Name: MRS. SANDRA M. CHAMBERLIN
Title or Position: CEO
Credential: M.S.
Phone: 570-323-7000