Provider Demographics
NPI:1013218445
Name:BECKENDORF, MARK ALAN (IA HEARING AID SPECI)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:BECKENDORF
Suffix:
Gender:M
Credentials:IA HEARING AID SPECI
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3717 CENTER POINT ROAD NE
Mailing Address - Street 2:#200
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402
Mailing Address - Country:US
Mailing Address - Phone:319-393-8994
Mailing Address - Fax:319-393-0895
Practice Address - Street 1:3717 CENTER POINT ROAD NE
Practice Address - Street 2:#200
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-393-8994
Practice Address - Fax:319-393-0895
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001015237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist