Healthcare Provider Details

I. General information

NPI: 1609602564
Provider Name (Legal Business Name): ACTIVEEAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 E WASHINGTON AVE
MADISON WI
53704-5206
US

IV. Provider business mailing address

2040 E WASHINGTON AVE
MADISON WI
53704-5206
US

V. Phone/Fax

Practice location:
  • Phone: 608-249-4077
  • Fax:
Mailing address:
  • Phone: 608-249-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARA LIPPOLD
Title or Position: OFFICE MANAGER
Credential:
Phone: 608-249-4077