Provider Demographics
NPI:1700558467
Name:WALLACE CENTER FOR HEARING, LLC
Entity Type:Organization
Organization Name:WALLACE CENTER FOR HEARING, LLC
Other - Org Name:WALLACE CENTER FOR HEARING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:815-233-3201
Mailing Address - Street 1:3436 E 325TH RD
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-9734
Mailing Address - Country:US
Mailing Address - Phone:815-866-2084
Mailing Address - Fax:
Practice Address - Street 1:4127 PROGRESS BLVD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1112
Practice Address - Country:US
Practice Address - Phone:815-223-3201
Practice Address - Fax:815-223-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty