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General NPI Number Information
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NPI Number | 1164743316
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Entity Type | Organization
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Legal Business Name | BLACIKWELL HEARING CENTER LLC
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 3200 MESA WAY SUITE D
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City | LAWRENCE
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State | KS
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Zip | 66049-2346
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Country | US
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Telephone | 785-841-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 MESA WAY SUITE D
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City | LAWRENCE
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State | KS
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Zip | 66049-2346
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Country | US
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Telephone | 785-841-4327
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MRS. WENDY L BLACKWELL
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Credential | MA, CCC-A, F-AAA
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Telephone | 785-841-4327
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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 | 1944
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License Number State | KS
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