Provider Demographics
NPI:1922203298
Name:MIDWEST AUDIOLOGY INC.
Entity Type:Organization
Organization Name:MIDWEST AUDIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RAMSEY
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:815-288-1111
Mailing Address - Street 1:109 POOLER AVE
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4626
Mailing Address - Country:US
Mailing Address - Phone:181-575-1224
Mailing Address - Fax:815-754-0993
Practice Address - Street 1:404 N GALENA AVE
Practice Address - Street 2:STE 120
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-2115
Practice Address - Country:US
Practice Address - Phone:815-288-1111
Practice Address - Fax:815-288-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03803OtherHEARUSA, HEARING CARE NET