Provider Demographics
NPI:1710915459
Name:BECKER AUDIOLOGY SC
Entity Type:Organization
Organization Name:BECKER AUDIOLOGY SC
Other - Org Name:BECKER AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:262-717-9000
Mailing Address - Street 1:20720 WATERTOWN RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1823
Mailing Address - Country:US
Mailing Address - Phone:262-717-9000
Mailing Address - Fax:
Practice Address - Street 1:20720 WATERTOWN RD
Practice Address - Street 2:SUITE #102
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1823
Practice Address - Country:US
Practice Address - Phone:262-717-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6-156261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech