Provider Demographics
NPI:1134318504
Name:ALBERT, KENNETH DALE JR (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DALE
Last Name:ALBERT
Suffix:JR
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-2097
Mailing Address - Country:US
Mailing Address - Phone:309-833-5202
Mailing Address - Fax:
Practice Address - Street 1:501 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2097
Practice Address - Country:US
Practice Address - Phone:309-833-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2822237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist