MEDICARE: TRISSI BOWLIN B.A, H.I.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	80476	TX

General Provider Information

NPI Number	:	1396026241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISSI BOWLIN B.A, H.I.S.

Provider Business Mailing Address
First Line	:	215 SHUMAN BLVD STE 401
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8123
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	6809 W NORTHWEST HWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-4202
Country	:	US
Telephone Number	:	214-691-5466
Fax Number	:	214-691-7250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	03/20/2020

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