Provider Demographics
NPI:1477953800
Name:HANNOLD, WILSON III (BC-HIS, HAD)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:HANNOLD
Suffix:III
Gender:M
Credentials:BC-HIS, HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:PILESGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-3140
Mailing Address - Country:US
Mailing Address - Phone:800-508-5450
Mailing Address - Fax:302-351-6677
Practice Address - Street 1:4512 KIRKWOOD HWY STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5125
Practice Address - Country:US
Practice Address - Phone:800-508-5450
Practice Address - Fax:302-351-6677
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00099000237700000X
DE03-0000273237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist