Provider Demographics
NPI:1821235888
Name:REVELATION HEARING, INC
Entity Type:Organization
Organization Name:REVELATION HEARING, INC
Other - Org Name:REVELATION HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:208-861-3626
Mailing Address - Street 1:3050 N LAKE HARBOR LN STE 146
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-6354
Mailing Address - Country:US
Mailing Address - Phone:208-343-2921
Mailing Address - Fax:208-854-1163
Practice Address - Street 1:3050 N LAKE HARBOR LN STE 146
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6354
Practice Address - Country:US
Practice Address - Phone:208-343-2921
Practice Address - Fax:208-854-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-1017237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty