Provider Demographics
NPI:1235478777
Name:HEARING ADVANTAGE LLC
Entity Type:Organization
Organization Name:HEARING ADVANTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-362-3711
Mailing Address - Street 1:5404 ALDERSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2293
Mailing Address - Country:US
Mailing Address - Phone:715-298-4437
Mailing Address - Fax:715-298-4439
Practice Address - Street 1:188 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-1221
Practice Address - Country:US
Practice Address - Phone:715-298-4437
Practice Address - Fax:715-298-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI573156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42837100Medicaid