Provider Demographics
NPI:1629220371
Name:HEARING CHOICES DBA JEFFERSON HEARING AID
Entity Type:Organization
Organization Name:HEARING CHOICES DBA JEFFERSON HEARING AID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOVACIK
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-A
Authorized Official - Phone:630-226-0327
Mailing Address - Street 1:391 QUADRANGLE DR
Mailing Address - Street 2:SUITE S-1
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3442
Mailing Address - Country:US
Mailing Address - Phone:630-226-0327
Mailing Address - Fax:
Practice Address - Street 1:391 QUADRANGLE DR
Practice Address - Street 2:SUITE S-1
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3442
Practice Address - Country:US
Practice Address - Phone:630-226-0327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000011231H00000X
IL147001095231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK44834Medicare UPIN
ILK44833Medicare UPIN
IL215603Medicare PIN