Provider Demographics
NPI:1831660315
Name:QUEDNAU HEARING. INC
Entity Type:Organization
Organization Name:QUEDNAU HEARING. INC
Other - Org Name:QUEDNAU HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEDNAU
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:217-693-7085
Mailing Address - Street 1:2916 CROSSING CT STE B
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-5900
Mailing Address - Country:US
Mailing Address - Phone:217-693-7085
Mailing Address - Fax:
Practice Address - Street 1:2916 CROSSING CT STE B
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-5900
Practice Address - Country:US
Practice Address - Phone:217-693-7085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1770050122Medicaid