{
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"OrgName": "PROFESSIONAL HEARING AND AUDIOLOGY CLINICS LTD",
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"FirstLineMailingAddress": "805 E STATE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHERRY VALLEY",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61016-9363",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-332-5350",
"MailingAddressFaxNumber": "815-332-9668",
"FirstLinePracticeLocationAddress": "5133 W TERRACE DR",
"SecondLinePracticeLocationAddress": "SUITE 203",
"PracticeLocationAddressCityName": "MADISON",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53718-2142",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "608-443-1016",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/06/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KLEINDL",
"AuthorizedOfficialFirstName": "DONALD",
"AuthorizedOfficialMiddleName": "R",
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"AuthorizedOfficialNameSuffix": "II",
"AuthorizedOfficialCredential": "BC, ACA, HIS, MCAP",
"AuthorizedOfficialTelephoneNumber": "815-979-4112",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Audiologist-Hearing Aid Fitter",
"LicenseNumber": "0229",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}