Provider Demographics
NPI:1689879835
Name:NORTHWEST PROFESSIONAL HEARING CENTERS, INC.
Entity Type:Organization
Organization Name:NORTHWEST PROFESSIONAL HEARING CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MICHALAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-579-9458
Mailing Address - Street 1:6555 WILLOW SPRINGS RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4591
Mailing Address - Country:US
Mailing Address - Phone:708-579-9458
Mailing Address - Fax:708-579-9561
Practice Address - Street 1:6555 WILLOW SPRINGS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-4591
Practice Address - Country:US
Practice Address - Phone:708-579-9458
Practice Address - Fax:708-579-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2830231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633818OtherBLUECROSS BLUESHIELD
IL346563304001Medicaid
IL1912037839OtherPROVIDER JILL MICHALAK