Healthcare Provider Details

I. General information

NPI: 1538340468
Provider Name (Legal Business Name): SHERI L MCGLONE BC HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 CALUMET AVE EXELA HEARING SERVICES
MANITOWOC WI
54220-5427
US

IV. Provider business mailing address

3415 CALUMET AVE EXELA HEARING SERVICES
MANITOWOC WI
54220-5427
US

V. Phone/Fax

Practice location:
  • Phone: 920-652-0190
  • Fax: 920-652-0178
Mailing address:
  • Phone: 920-652-0190
  • Fax: 920-652-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number929
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier42826700
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: