Provider Demographics
NPI:1841792660
Name:AFFORDABLE HEARING CLINIC
Entity Type:Organization
Organization Name:AFFORDABLE HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:JENDRASIAK
Authorized Official - Suffix:II
Authorized Official - Credentials:BA, HAD
Authorized Official - Phone:616-591-2882
Mailing Address - Street 1:833 KENMOOR AVE SE STE G
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2390
Mailing Address - Country:US
Mailing Address - Phone:616-591-2882
Mailing Address - Fax:
Practice Address - Street 1:833 KENMOOR AVE SE STE G
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-591-2882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004977237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty