Provider Demographics
NPI:1629507769
Name:NORTH RIDGE HEARING CO. LLC
Entity Type:Organization
Organization Name:NORTH RIDGE HEARING CO. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP AAAF
Authorized Official - Phone:715-381-3111
Mailing Address - Street 1:1516 N RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1879
Mailing Address - Country:US
Mailing Address - Phone:715-381-3111
Mailing Address - Fax:715-386-1760
Practice Address - Street 1:900 CREST VIEW DR STE 210
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9517
Practice Address - Country:US
Practice Address - Phone:715-381-3111
Practice Address - Fax:715-386-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-11
Last Update Date:2017-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI454156332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIN036203OtherSTATE OF WI FILE NUMBER FOR BUSINESS REGISTRATION