Provider Demographics
NPI:1164069316
Name:HANERHOFF, MARCUS J (HIA)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:J
Last Name:HANERHOFF
Suffix:
Gender:M
Credentials:HIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2882 AAA CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3406
Mailing Address - Country:US
Mailing Address - Phone:563-888-5282
Mailing Address - Fax:
Practice Address - Street 1:2882 AAA CT
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3406
Practice Address - Country:US
Practice Address - Phone:563-888-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081476237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist