Provider Demographics
NPI:1497092597
Name:MODERN HEARING SOLUTIONS LLC
Entity Type:Organization
Organization Name:MODERN HEARING SOLUTIONS LLC
Other - Org Name:MODERN HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, HIS
Authorized Official - Phone:920-434-6800
Mailing Address - Street 1:2314 LINEVILLE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-8860
Mailing Address - Country:US
Mailing Address - Phone:920-434-6800
Mailing Address - Fax:920-434-7084
Practice Address - Street 1:2314 LINEVILLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-8860
Practice Address - Country:US
Practice Address - Phone:920-434-6800
Practice Address - Fax:920-434-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1305-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42840600Medicaid