Provider Demographics
NPI:1710984562
Name:HUDSON HEARING & SPEECH CLINIC INC
Entity Type:Organization
Organization Name:HUDSON HEARING & SPEECH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DREVNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, F/AAA
Authorized Official - Phone:715-531-6710
Mailing Address - Street 1:401 STAGELINE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7897
Mailing Address - Country:US
Mailing Address - Phone:715-531-6710
Mailing Address - Fax:715-531-6711
Practice Address - Street 1:401 STAGELINE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7897
Practice Address - Country:US
Practice Address - Phone:715-531-6710
Practice Address - Fax:715-531-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173-156231H00000X
WI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41121100Medicaid
WI41121100Medicaid