Provider Demographics
NPI:1831532712
Name:WESTERN COLORADO HEARING CLINIC
Entity type:Organization
Organization Name:WESTERN COLORADO HEARING CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEBEE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:970-270-4986
Mailing Address - Street 1:2139 N 12TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2910
Mailing Address - Country:US
Mailing Address - Phone:970-549-4660
Mailing Address - Fax:970-549-4658
Practice Address - Street 1:2139 N 12TH ST STE 4
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2910
Practice Address - Country:US
Practice Address - Phone:970-549-4660
Practice Address - Fax:970-549-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO614231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000179890Medicaid
CO85756067Medicaid