Healthcare Provider Details

I. General information

NPI: 1710984562
Provider Name (Legal Business Name): HUDSON HEARING & SPEECH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 STAGELINE RD SUITE 6
HUDSON WI
54016-7897
US

IV. Provider business mailing address

401 STAGELINE RD SUITE 6
HUDSON WI
54016-7897
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6710
  • Fax: 715-531-6711
Mailing address:
  • Phone: 715-531-6710
  • Fax: 715-531-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number173-156
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateWI

VIII. Authorized Official

Name: MRS. MICHELE ANNE DREVNICK
Title or Position: PRESIDENT
Credential: MS, F/AAA
Phone: 715-531-6710