Provider Demographics
NPI:1316020217
Name:HANERHOFF, JAMES A (ACA,HIS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:HANERHOFF
Suffix:
Gender:M
Credentials:ACA,HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 VALLEY VIEW DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6138
Mailing Address - Country:US
Mailing Address - Phone:309-764-3065
Mailing Address - Fax:309-764-3204
Practice Address - Street 1:505 VALLEY VIEW DR
Practice Address - Street 2:SUITE #2
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:309-764-3065
Practice Address - Fax:309-764-3204
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2610237700000X
IA953237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist