Provider Demographics
NPI:1831433416
Name:AUGUSTANA COLLEGE
Entity type:Organization
Organization Name:AUGUSTANA COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:309-794-7388
Mailing Address - Street 1:639 38TH ST
Mailing Address - Street 2:CSD/BRODAHL BUILDING
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-2210
Mailing Address - Country:US
Mailing Address - Phone:309-794-7350
Mailing Address - Fax:309-794-3497
Practice Address - Street 1:639 38TH ST
Practice Address - Street 2:CSD/BRODAHL BUILDING
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-2210
Practice Address - Country:US
Practice Address - Phone:309-794-7350
Practice Address - Fax:309-794-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001413237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty