Provider Demographics
NPI:1417384496
Name:THE HEARING LAB LLC
Entity Type:Organization
Organization Name:THE HEARING LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:855-703-4637
Mailing Address - Street 1:2151 BLUESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6704
Mailing Address - Country:US
Mailing Address - Phone:855-703-4637
Mailing Address - Fax:636-946-1754
Practice Address - Street 1:2151 BLUESTONE DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6704
Practice Address - Country:US
Practice Address - Phone:855-703-4637
Practice Address - Fax:636-946-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4118-4203237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty