Provider Demographics
NPI:1649583998
Name:GREENLEAF HEARING HEALTHCARE LLC
Entity Type:Organization
Organization Name:GREENLEAF HEARING HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCQUEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MC CCC-A
Authorized Official - Phone:317-468-8545
Mailing Address - Street 1:605 WATERVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1373
Mailing Address - Country:US
Mailing Address - Phone:317-468-8545
Mailing Address - Fax:317-462-5358
Practice Address - Street 1:24 N. STATE STREET
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1373
Practice Address - Country:US
Practice Address - Phone:317-468-8545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty