Provider Demographics
NPI:1700024858
Name:INTEGRATED AUDIOLOGY CARE PC
Entity Type:Organization
Organization Name:INTEGRATED AUDIOLOGY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:LAROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:312-730-7339
Mailing Address - Street 1:600 N DEARBORN ST
Mailing Address - Street 2:#1308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6284
Mailing Address - Country:US
Mailing Address - Phone:312-751-9677
Mailing Address - Fax:312-751-9677
Practice Address - Street 1:1034 WARREN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3601
Practice Address - Country:US
Practice Address - Phone:312-751-9677
Practice Address - Fax:312-751-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.000224231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty