Provider Demographics
NPI:1558646299
Name:SELECTIVE HEARING CENTERS, LLC
Entity Type:Organization
Organization Name:SELECTIVE HEARING CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-577-5577
Mailing Address - Street 1:6804 GREEN BAY RD STE 113
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-1451
Mailing Address - Country:US
Mailing Address - Phone:262-577-5577
Mailing Address - Fax:262-577-5511
Practice Address - Street 1:6804 GREEN BAY RD STE 113
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-1451
Practice Address - Country:US
Practice Address - Phone:262-577-5577
Practice Address - Fax:262-577-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1310-060332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment