MEDICARE: HEARING WELLNESS CENTER

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	231H00000X	Audiologist
2	237600000X	Audiologist-Hearing Aid Fitter
3	231H00000X	Audiologist	6443	MN

General Provider Information

NPI Number	:	1649530361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARING WELLNESS CENTER

Provider Business Mailing Address
First Line	:	1525 LONDON RD
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55812-1617
Country	:	US
Telephone Number	:	218-623-1045
Fax Number	:	218-724-1096

Provider Business Practice Location Address
First Line	:	1525 LONDON RD
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55812-1617
Country	:	US
Telephone Number	:	218-623-1045
Fax Number	:	218-724-1096

Authorized Official
Title or Position	:	AUDIOLOGIST
Name	:	DR. JONATHAN P GERVAIS
Credential	:	AU.D.
Telephone Number	:	218-623-1045

Provider Enumeration Date	:	05/29/2012
Last Update Date	:	05/19/2020

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Directions to “HEARING WELLNESS CENTER ” Practice Location

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