Provider Demographics
NPI:1316210966
Name:HEARING CARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:HEARING CARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:MATULLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:608-752-3529
Mailing Address - Street 1:20 S MAIN ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-3959
Mailing Address - Country:US
Mailing Address - Phone:608-752-3529
Mailing Address - Fax:
Practice Address - Street 1:20 S MAIN ST
Practice Address - Street 2:SUITE 14
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3959
Practice Address - Country:US
Practice Address - Phone:608-752-3529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41110400Medicaid
WI41110400Medicaid