Provider Demographics
NPI:1689089856
Name:S.E. WISCONSIN HEARING CENTER INC.
Entity Type:Organization
Organization Name:S.E. WISCONSIN HEARING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:262-884-4327
Mailing Address - Street 1:6015 DURAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5044
Mailing Address - Country:US
Mailing Address - Phone:262-884-4327
Mailing Address - Fax:262-884-4327
Practice Address - Street 1:6015 DURAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-5044
Practice Address - Country:US
Practice Address - Phone:262-884-4327
Practice Address - Fax:262-884-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1371060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1508141003Medicaid