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General NPI Number Information
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NPI Number | 1114198157
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Entity Type | Organization
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Legal Business Name | INNOVATIVE HEARING SERVICES, INC.
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 2766 W 11 MILE RD SUITE 8
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City | BERKLEY
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State | MI
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Zip | 48072-3033
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Country | US
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Telephone | 248-544-0560
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Fax | 248-544-7480
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Provider Business Mailing Address
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Address Line | 2766 W 11 MILE RD SUITE 8
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City | BERKLEY
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State | MI
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Zip | 48072-3033
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Country | US
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Telephone | 248-544-0560
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Fax | 248-544-7480
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MRS. CINDY BAZELL WILSON
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Credential | M.A. CCC-A/FAAA
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Telephone | 248-544-0560
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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 | 1601000293
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 3501002743
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License Number State | MI
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