Provider Demographics
NPI:1861728271
Name:HEARING SERVICES
Entity type:Organization
Organization Name:HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:N
Authorized Official - Last Name:HEISTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-627-4199
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-0185
Mailing Address - Country:US
Mailing Address - Phone:715-627-4199
Mailing Address - Fax:
Practice Address - Street 1:723 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2011
Practice Address - Country:US
Practice Address - Phone:715-627-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1182 060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty