Provider Demographics
NPI:1679708929
Name:CENTRAL ILLINOIS HEARING & SPEECH LTD
Entity Type:Organization
Organization Name:CENTRAL ILLINOIS HEARING & SPEECH LTD
Other - Org Name:CENTRAL ILLINOIS HEARING LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROESCH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:217-726-6101
Mailing Address - Street 1:4000 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7066
Mailing Address - Country:US
Mailing Address - Phone:217-726-6101
Mailing Address - Fax:217-726-6103
Practice Address - Street 1:4000 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7066
Practice Address - Country:US
Practice Address - Phone:217-726-6101
Practice Address - Fax:217-726-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000273231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty