Provider Demographics
NPI:1568032894
Name:LITTLE HEROES PEDIATRIC HEARING CLINIC, LLC
Entity Type:Organization
Organization Name:LITTLE HEROES PEDIATRIC HEARING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHICKER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:801-996-7512
Mailing Address - Street 1:1240 E HIGHWAY 193 STE G2
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-8544
Mailing Address - Country:US
Mailing Address - Phone:801-996-7510
Mailing Address - Fax:
Practice Address - Street 1:1240 E HIGHWAY 193 STE G2
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-8544
Practice Address - Country:US
Practice Address - Phone:801-996-7510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty