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General NPI Number Information
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NPI Number | 1043755382
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Entity Type | Organization
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Legal Business Name | CARLYLE HEARING CENTER LLC
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 811 FAIRFAX ST
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City | CARLYLE
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State | IL
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Zip | 62231-1809
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Country | US
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Telephone | 618-594-4966
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Fax | 618-205-5067
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Provider Business Mailing Address
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Address Line | 811 FAIRFAX ST
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City | CARLYLE
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State | IL
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Zip | 62231-1809
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Country | US
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Telephone | 618-594-4966
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Fax | 618-205-5067
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Authorized Official
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Title or Position | AUDIOLOGIST/OWNER
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Name | DR. REBEKAH DONNELLY
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Credential | AUD
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Telephone | 618-594-4966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 147000882
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License Number State | IL
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