Provider Demographics
NPI:1689899874
Name:PROFESSIONAL AUDIOLOGY, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL AUDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KLODD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-924-2931
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-0043
Mailing Address - Country:US
Mailing Address - Phone:847-674-8761
Mailing Address - Fax:847-674-8764
Practice Address - Street 1:800 AUSTIN ST STE 360E
Practice Address - Street 2:STE 256 EAST
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3454
Practice Address - Country:US
Practice Address - Phone:847-674-8761
Practice Address - Fax:847-674-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14700269231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty