Healthcare Provider Details

I. General information

NPI: 1952350324
Provider Name (Legal Business Name): HEAR WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 W NATIONAL AVE
WEST ALLIS WI
53227-2028
US

IV. Provider business mailing address

10243 W NATIONAL AVE
WEST ALLIS WI
53227-2028
US

V. Phone/Fax

Practice location:
  • Phone: 414-604-2200
  • Fax: 414-604-7200
Mailing address:
  • Phone: 414-604-2200
  • Fax: 414-604-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD PHALEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 414-604-7201