Provider Demographics
NPI:1073991543
Name:EVERCLEAR HEARING PRODUCTS
Entity Type:Organization
Organization Name:EVERCLEAR HEARING PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:ROGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:715-831-0289
Mailing Address - Street 1:2215 E CLAIREMONT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4772
Mailing Address - Country:US
Mailing Address - Phone:715-831-0289
Mailing Address - Fax:715-831-4722
Practice Address - Street 1:2215 E CLAIREMONT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4772
Practice Address - Country:US
Practice Address - Phone:715-831-0289
Practice Address - Fax:715-831-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30-156237600000X
WI1285-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42839500Medicaid