Provider Demographics
NPI:1659552701
Name:LAWRENCE CLAYTON & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LAWRENCE CLAYTON & ASSOCIATES, LLC
Other - Org Name:HEARING HEALTHCARE OF ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TACKABERRY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:815-399-5279
Mailing Address - Street 1:435 N MULFORD RD STE 10
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5100
Mailing Address - Country:US
Mailing Address - Phone:815-399-5279
Mailing Address - Fax:815-399-3764
Practice Address - Street 1:435 N MULFORD RD STE 10
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5100
Practice Address - Country:US
Practice Address - Phone:815-399-5279
Practice Address - Fax:815-399-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000198237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19603Medicare UPIN