Provider Demographics
NPI:1477855435
Name:HEARN, RUSSELL B
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:B
Last Name:HEARN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 N MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1956
Mailing Address - Country:US
Mailing Address - Phone:724-282-8491
Mailing Address - Fax:724-282-8520
Practice Address - Street 1:1022 N MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1956
Practice Address - Country:US
Practice Address - Phone:724-282-8491
Practice Address - Fax:724-282-8520
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF-0240300237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist