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General NPI Number Information
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NPI Number | 1760763908
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Entity Type | Organization
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Legal Business Name | STREATOR HEARING CARE LLC
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 205 S PARK ST
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City | STREATOR
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State | IL
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Zip | 61364-4448
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Country | US
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Telephone | 815-673-2869
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Fax | 815-672-9225
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Provider Business Mailing Address
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Address Line | 205 S PARK ST
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City | STREATOR
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State | IL
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Zip | 61364-4448
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Country | US
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Telephone | 815-673-2869
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Fax | 815-672-9225
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Authorized Official
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Title or Position | OWNER
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Name | DARCY L BEALS
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Credential | MS CCC-A
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Telephone | 815-673-2869
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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 | 147.000596
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License Number State | IL
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