Provider Demographics
NPI:1013425339
Name:JAMES, JONATHAN WAYNE (HEARING AID DEALER)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WAYNE
Last Name:JAMES
Suffix:
Gender:M
Credentials:HEARING AID DEALER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 15TH 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-5607
Mailing Address - Country:US
Mailing Address - Phone:812-882-4715
Mailing Address - Fax:812-882-4922
Practice Address - Street 1:601 N 15 1/2 STREET
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4759
Practice Address - Country:US
Practice Address - Phone:812-882-4715
Practice Address - Fax:812-882-4922
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN770019588237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN17001169AOtherINDIANA PROFESSIONAL LICENSING AGENCY