Provider Demographics
NPI:1013958941
Name:PATTI L ALLY
Entity Type:Organization
Organization Name:PATTI L ALLY
Other - Org Name:ALLY HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:309-282-0887
Mailing Address - Street 1:5401 N KNOXVILLE AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5021
Mailing Address - Country:US
Mailing Address - Phone:309-282-0887
Mailing Address - Fax:309-282-0947
Practice Address - Street 1:5401 N KNOXVILLE AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5098
Practice Address - Country:US
Practice Address - Phone:309-282-0887
Practice Address - Fax:309-282-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL353701941001Medicaid
IL626150Medicare ID - Type Unspecified