Provider Demographics
NPI:1790043982
Name:QUINCY AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:QUINCY AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:217-779-9058
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62306-0489
Mailing Address - Country:US
Mailing Address - Phone:217-779-9058
Mailing Address - Fax:
Practice Address - Street 1:1622 VERMONT ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3156
Practice Address - Country:US
Practice Address - Phone:217-779-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.000916231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty