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General NPI Number Information
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NPI Number | 1912246240
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Entity Type | Organization
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Legal Business Name | HEARING ADVANTAGE LLC
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 11122 TUCKAWAY RD
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City | WOODRUFF
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State | WI
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Zip | 54568-9761
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Country | US
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Telephone | 715-298-4437
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Fax | 715-298-4439
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Provider Business Mailing Address
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Address Line | 5404 ALDERSON ST SUITE 200
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City | SCHOFIELD
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State | WI
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Zip | 54476-2293
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Country | US
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Telephone | 715-298-4437
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Fax | 715-298-4439
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MR. JESSE C KASTER
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Credential |
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Telephone | 715-298-4437
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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 | 573156
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License Number State | WI
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