Provider Demographics
NPI:1982893871
Name:SUSAN SACKS AUDIOLOGY SERVICES P.C.
Entity Type:Organization
Organization Name:SUSAN SACKS AUDIOLOGY SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-377-1138
Mailing Address - Street 1:960 N 5TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:960 N 5TH AVE STE A
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1205
Practice Address - Country:US
Practice Address - Phone:630-377-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1699724211OtherNPI
IL270867024001Medicaid
IL1407966278OtherNPI
IL530744404001Medicaid
IL1407966278OtherNPI