Provider Demographics
NPI:1477675510
Name:PROFESSIONAL HEARING AND AUDIOLOGY CLINICS LTD
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING AND AUDIOLOGY CLINICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AUDIOPROSTHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KLEINDL
Authorized Official - Suffix:II
Authorized Official - Credentials:BC, ACA, HIS, MCAP
Authorized Official - Phone:815-979-4112
Mailing Address - Street 1:805 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61016-9363
Mailing Address - Country:US
Mailing Address - Phone:815-332-5350
Mailing Address - Fax:815-332-9668
Practice Address - Street 1:5133 W TERRACE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-2142
Practice Address - Country:US
Practice Address - Phone:608-443-1016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0229237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty