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General NPI Number Information
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NPI Number | 1700024858
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Entity Type | Organization
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Legal Business Name | INTEGRATED AUDIOLOGY CARE PC
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 1034 WARREN AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3601
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Country | US
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Telephone | 312-751-9677
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Fax | 312-751-9677
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Provider Business Mailing Address
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Address Line | 600 N DEARBORN ST #1308
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City | CHICAGO
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State | IL
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Zip | 60654-6284
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Country | US
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Telephone | 312-751-9677
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Fax | 312-751-9677
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MR. ROGER WALTER LAROSE
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Credential | M.A.
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Telephone | 312-730-7339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147.000224
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License Number State | IL
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