Provider Demographics
NPI:1043755382
Name:CARLYLE HEARING CENTER LLC
Entity Type:Organization
Organization Name:CARLYLE HEARING CENTER LLC
Other - Org Name:CARLYLE HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:618-594-4966
Mailing Address - Street 1:811 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-1809
Mailing Address - Country:US
Mailing Address - Phone:618-594-4966
Mailing Address - Fax:618-205-5067
Practice Address - Street 1:811 FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-1809
Practice Address - Country:US
Practice Address - Phone:618-594-4966
Practice Address - Fax:618-205-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000882237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty