Provider Demographics
NPI:1396089975
Name:NORTHWESTERN UNIVERSITY AUDIOLOGY CLINIC
Entity type:Organization
Organization Name:NORTHWESTERN UNIVERSITY AUDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE CHAIR
Authorized Official - Prefix:PROF
Authorized Official - First Name:SUMITRAJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-491-2470
Mailing Address - Street 1:2240 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-3550
Mailing Address - Country:US
Mailing Address - Phone:847-491-3165
Mailing Address - Fax:847-467-0410
Practice Address - Street 1:2240 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-3550
Practice Address - Country:US
Practice Address - Phone:847-491-3165
Practice Address - Fax:847-467-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology AssistantGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty