Healthcare Provider Details

I. General information

NPI: 1710915459
Provider Name (Legal Business Name): BECKER AUDIOLOGY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20720 WATERTOWN RD SUITE #102
WAUKESHA WI
53186-1823
US

IV. Provider business mailing address

20720 WATERTOWN RD SUITE #102
WAUKESHA WI
53186-1823
US

V. Phone/Fax

Practice location:
  • Phone: 262-717-9000
  • Fax:
Mailing address:
  • Phone: 262-717-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number6-156
License Number StateWI

VIII. Authorized Official

Name: TIM RICHARD BECKER
Title or Position: OWNER
Credential: AU.D
Phone: 262-717-9000