Provider Demographics
NPI:1205158904
Name:ABUNDANT LIFE HEARING HEALTH & MORE, INC.
Entity type:Organization
Organization Name:ABUNDANT LIFE HEARING HEALTH & MORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:920-682-4990
Mailing Address - Street 1:2525 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4821
Mailing Address - Country:US
Mailing Address - Phone:920-682-4990
Mailing Address - Fax:920-682-4990
Practice Address - Street 1:2525 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4821
Practice Address - Country:US
Practice Address - Phone:920-682-4990
Practice Address - Fax:920-682-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1169-060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty