Provider Demographics
NPI:1720385107
Name:INNOVATIVE HEARING SERVICES, LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEARING SERVICES, LLC
Other - Org Name:SONUS SF0014
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A, FAAA
Authorized Official - Phone:630-325-6133
Mailing Address - Street 1:201 E OGDEN AVE
Mailing Address - Street 2:STE 126
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3633
Mailing Address - Country:US
Mailing Address - Phone:630-325-6133
Mailing Address - Fax:630-325-4751
Practice Address - Street 1:201 E OGDEN AVE
Practice Address - Street 2:SUITE 126
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3633
Practice Address - Country:US
Practice Address - Phone:630-325-6133
Practice Address - Fax:630-325-4751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-19
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty