Provider Demographics
NPI:1710498019
Name:HEARKEN HEARING & AUDIOLOGY LLC
Entity Type:Organization
Organization Name:HEARKEN HEARING & AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:660-956-9156
Mailing Address - Street 1:915 S BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4027
Mailing Address - Country:US
Mailing Address - Phone:660-956-9156
Mailing Address - Fax:660-956-9151
Practice Address - Street 1:915 S BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4027
Practice Address - Country:US
Practice Address - Phone:660-956-9156
Practice Address - Fax:660-956-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016026739231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty