Provider Demographics
NPI:1578934006
Name:LIFE HEARING AND AUDIOLOGY CLINICS
Entity Type:Organization
Organization Name:LIFE HEARING AND AUDIOLOGY CLINICS
Other - Org Name:LIFE HEARING HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINDL
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:815-979-4112
Mailing Address - Street 1:720 GOODLETTE FRANK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5656
Mailing Address - Country:US
Mailing Address - Phone:239-649-5433
Mailing Address - Fax:
Practice Address - Street 1:720 GOODLETTE FRANK RD STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5656
Practice Address - Country:US
Practice Address - Phone:239-649-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4987237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty