=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093920282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL HEARING MANAGEMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2601 BEECH ST
-----------------------------------------------------
City | VALPARAISO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46383-6008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-464-9580
-----------------------------------------------------
Fax | 219-464-0640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2601 BEECH ST
-----------------------------------------------------
City | VALPARAISO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46383-6008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-464-9580
-----------------------------------------------------
Fax | 219-464-0640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR PRESIDENT
-----------------------------------------------------
Name | DR. NANCY A DICKEY
-----------------------------------------------------
Credential | AU.D.
-----------------------------------------------------
Telephone | 219-464-9580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 23001381A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------