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General NPI Number Information
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NPI Number | 1528225596
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Entity Type | Organization
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Legal Business Name | SYCAMORE HEARING AID CENTER
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 2535 BETHANY RD SUITE 100
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City | SYCAMORE
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State | IL
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Zip | 60178-3126
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Country | US
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Telephone | 815-787-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 2535 BETHANY ROAD SUITE 100
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City | SYCAMORE
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State | IL
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Zip | 60178
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Country | US
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Telephone | 815-787-4327
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SANDRA BROADDUS
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Credential | M S CCC A
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Telephone | 815-787-4237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 147-000688
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 147-000688
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License Number State | IL
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