Provider Demographics
NPI:1336874056
Name:DUNCKLEY AUDIOLOGY
Entity Type:Organization
Organization Name:DUNCKLEY AUDIOLOGY
Other - Org Name:EVANSTON AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:DUNCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:872-230-1158
Mailing Address - Street 1:1811 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3750
Mailing Address - Country:US
Mailing Address - Phone:847-453-3643
Mailing Address - Fax:
Practice Address - Street 1:1811 BENSON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3750
Practice Address - Country:US
Practice Address - Phone:847-453-3643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech