Provider Demographics
NPI:1003010364
Name:HEARING PROFESSIONALS OF ILLINOIS
Entity Type:Organization
Organization Name:HEARING PROFESSIONALS OF ILLINOIS
Other - Org Name:FORMERLY AUDIOLOGICAL LABORATORY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF AUDIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:MERLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MA, CCCA
Authorized Official - Phone:847-674-5585
Mailing Address - Street 1:8780 GOLF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-674-5585
Mailing Address - Fax:847-824-1712
Practice Address - Street 1:8780 GOLF RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-824-4390
Practice Address - Fax:847-824-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000108231H00000X
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty