Healthcare Provider Details

I. General information

NPI: 1861731432
Provider Name (Legal Business Name): HEARING ADVANTAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 ALDERSON ST SUITE 200
SCHOFIELD WI
54476-2293
US

IV. Provider business mailing address

5404 ALDERSON ST SUITE 200
SCHOFIELD WI
54476-2293
US

V. Phone/Fax

Practice location:
  • Phone: 715-298-4437
  • Fax: 715-298-4439
Mailing address:
  • Phone: 715-298-4437
  • Fax: 715-298-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number573156
License Number StateWI

VIII. Authorized Official

Name: MR. JESSE C KASTER
Title or Position: BUSINESS OWNER
Credential: HEARING SPECIALIST
Phone: 715-298-4437