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General NPI Number Information
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NPI Number | 1053442491
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Entity Type | Organization
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Legal Business Name | NORTH SIDE AUDIOLOGY GROUP, INC.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 4200 W. PETERSON AVE. SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60646-6052
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Country | US
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Telephone | 773-777-3277
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Fax | 773-777-2878
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Provider Business Mailing Address
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Address Line | 4200 W. PETERSON AVE. SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60646-6052
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Country | US
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Telephone | 773-777-3277
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Fax | 773-777-2878
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MS. DARIA T POPOWYCH
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Credential | MS CCCA
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Telephone | 773-777-3277
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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 | 147000271
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147000241
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License Number State | IL
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