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General NPI Number Information
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NPI Number | 1558646299
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Entity Type | Organization
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Legal Business Name | SELECTIVE HEARING CENTERS, LLC
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 6804 GREEN BAY RD STE 113
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City | KENOSHA
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State | WI
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Zip | 53142-1451
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Country | US
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Telephone | 262-577-5577
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Fax | 262-577-5511
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Provider Business Mailing Address
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Address Line | 6804 GREEN BAY RD STE 113
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City | KENOSHA
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State | WI
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Zip | 53142-1451
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Country | US
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Telephone | 262-577-5577
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Fax | 262-577-5511
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Authorized Official
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Title or Position | PATIENT CARE COORDINATOR
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Name | CHERYL A. JOHNSTON
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Credential |
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Telephone | 262-577-5577
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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 | 1310-060
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License Number State | WI
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