Provider Demographics
NPI: | 1508033564 |
---|---|
Name: | COMMUNICATION INNOVATIONS, INC |
Entity Type: | Organization |
Organization Name: | COMMUNICATION INNOVATIONS, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | AMANDA |
Authorized Official - Middle Name: | RAE |
Authorized Official - Last Name: | HOUDEK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS CCC-SLP |
Authorized Official - Phone: | 608-772-2161 |
Mailing Address - Street 1: | 2927 S FISH HATCHERY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | FITCHBURG |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53711-6498 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 608-819-6394 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2927 S FISH HATCHERY RD |
Practice Address - Street 2: | |
Practice Address - City: | FITCHBURG |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53711-6498 |
Practice Address - Country: | US |
Practice Address - Phone: | 608-819-6394 |
Practice Address - Fax: | 608-204-6183 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-05-09 |
Last Update Date: | 2013-08-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 2559-154 | 261Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |