Healthcare Provider Details

I. General information

NPI: 1124498118
Provider Name (Legal Business Name): EXECUTIVE HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5068 W PLANO PKWY STE 300
PLANO TX
75093-4408
US

IV. Provider business mailing address

5068 W PLANO PKWY STE 300
PLANO TX
75093-4408
US

V. Phone/Fax

Practice location:
  • Phone: 972-447-8330
  • Fax: 972-381-4201
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number51344
License Number StateTX

VIII. Authorized Official

Name: MS. LAURIE BORNSTEIN
Title or Position: OWNER
Credential:
Phone: 972-447-8330