Provider Demographics
NPI:1952351090
Name:ENO, GARY R (AUD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:ENO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00368231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0100362Medicaid
235356OtherMIDLANDS CHOICE
IA0145OtherJOHN DEERE HEALTH
030515OtherHEALTH ALLIANCE
34505OtherIOWA HEALTH SOLUTIONS
IA0100362Medicaid
235356OtherMIDLANDS CHOICE
IA0100362Medicaid
34505OtherIOWA HEALTH SOLUTIONS