Provider Demographics
NPI:1124172820
Name:NELSON AUDIOLOGY, LTD
Entity type:Organization
Organization Name:NELSON AUDIOLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:BROOM
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:217-324-2433
Mailing Address - Street 1:220 E RYDER ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-2033
Mailing Address - Country:US
Mailing Address - Phone:217-324-2433
Mailing Address - Fax:217-324-3377
Practice Address - Street 1:220 E RYDER ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-2033
Practice Address - Country:US
Practice Address - Phone:217-324-2433
Practice Address - Fax:217-324-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000098231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL360529808001Medicaid
IL213137Medicare UPIN