Provider Demographics
NPI:1154587590
Name:ADHEARENCE, LLC
Entity type:Organization
Organization Name:ADHEARENCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:VAN WIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, SLP-L, CCC/A
Authorized Official - Phone:602-705-8705
Mailing Address - Street 1:6425 W CONSTANCE WAY
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2798
Mailing Address - Country:US
Mailing Address - Phone:602-705-8705
Mailing Address - Fax:602-323-2241
Practice Address - Street 1:6425 W CONSTANCE WAY
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2798
Practice Address - Country:US
Practice Address - Phone:602-705-8705
Practice Address - Fax:602-323-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAUD5402231H00000X
AZSLPL4532235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty