Provider Demographics
NPI:1003947748
Name:HAVILAND HEARING AIDS INC.
Entity Type:Organization
Organization Name:HAVILAND HEARING AIDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ZELLMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-A
Authorized Official - Phone:920-733-7525
Mailing Address - Street 1:1336 E WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3969
Mailing Address - Country:US
Mailing Address - Phone:920-733-7525
Mailing Address - Fax:
Practice Address - Street 1:1336 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3969
Practice Address - Country:US
Practice Address - Phone:920-733-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI359 156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42857800Medicaid