Provider Demographics
NPI:1801078407
Name:ERWIN TOWNE CO
Entity type:Organization
Organization Name:ERWIN TOWNE CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:TOWNE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:309-693-2717
Mailing Address - Street 1:5016 N UNIVERSITY ST
Mailing Address - Street 2:SUITE #110
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4781
Mailing Address - Country:US
Mailing Address - Phone:309-693-2717
Mailing Address - Fax:309-693-2776
Practice Address - Street 1:5016 N UNIVERSITY ST
Practice Address - Street 2:SUITE #110
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4781
Practice Address - Country:US
Practice Address - Phone:309-693-2717
Practice Address - Fax:309-693-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619165586OtherNPI