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General NPI Number Information
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NPI Number | 1023517091
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEARING ASSOCIATES LLC
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 1344 DADRIAN PROFESSIONAL PARK
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City | GODFREY
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State | IL
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Zip | 62035-1685
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Country | US
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Telephone | 618-466-4444
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Fax | 618-466-4444
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Provider Business Mailing Address
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Address Line | 1344 DADRIAN PROFESSIONAL PARK
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City | GODFREY
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State | IL
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Zip | 62035-1685
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Country | US
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Telephone | 618-466-4444
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Fax | 618-466-4444
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Authorized Official
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Title or Position | DOCTOR OF AUDIOLOGY
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Name | DR. COLDORE JOSEPH HOPPER IV
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Credential | AUD FAAA
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Telephone | 618-466-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147-000829
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License Number State | IL
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