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NPI 1497930762

NPI 1497930762 : LYNDI SUE HOFSTRA BS HIS : PALOS HEIGHTS, IL

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General NPI Number Information
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    NPI Number           |    1497930762
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    Entity Type          |    Individual 
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    Provider Name        |    LYNDI SUE HOFSTRA BS HIS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    01/07/2008
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    Last Update Date     |    01/07/2008
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Provider Practice Location Address
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    Address Line         |    12705 S RIDGELAND AVE HOFSTRA FAMILY HEARING
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    City                 |    PALOS HEIGHTS
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    State                |    IL
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    Zip                  |    60463
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    Country              |    US
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    Telephone            |    708-385-9402
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    Fax                  |    708-385-9403
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Provider Business Mailing Address
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    Address Line         |    12705 SO RIDGELAND AVE HOFSTRA FAMILY HEARING
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    City                 |    PALOS HEIGHTS
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    State                |    IL
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    Zip                  |    60463
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    Country              |    US
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    Telephone            |    708-385-9402
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    Fax                  |    708-385-9403
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    237700000X
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    Taxonomy Name        |    Hearing Instrument Specialist
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    License Number       |    2898
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    License Number State |    IL
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