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General NPI Number Information
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NPI Number | 1700558467
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Entity Type | Organization
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Legal Business Name | WALLACE CENTER FOR HEARING, LLC
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 4127 PROGRESS BLVD
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City | PERU
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State | IL
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Zip | 61354-1112
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Country | US
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Telephone | 815-223-3201
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Fax | 815-223-3202
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Provider Business Mailing Address
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Address Line | 3436 E 325TH RD
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City | LA SALLE
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State | IL
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Zip | 61301-9734
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Country | US
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Telephone | 815-866-2084
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MRS. BETH ANN WALLACE
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Credential | M.S.
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Telephone | 815-233-3201
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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 |
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License Number State |
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