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General NPI Number Information
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NPI Number | 1629520408
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Entity Type | Organization
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Legal Business Name | JACQULYN SLOAN-KEENAN
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 504 HOWARD ST
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City | BRIDGEPORT
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State | OH
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Zip | 43912-1126
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Country | US
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Telephone | 740-635-1535
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Fax | 740-635-0038
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Provider Business Mailing Address
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Address Line | 504 HOWARD ST
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City | BRIDGEPORT
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State | OH
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Zip | 43912-1126
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Country | US
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Telephone | 740-635-1535
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Fax | 740-635-0038
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AMY LYNN SIKORA
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Credential |
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Telephone | 740-635-1535
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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 | 2068
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License Number State | OH
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