Provider Demographics
NPI:1992062061
Name:SOUTH SUBURBAN HEARING, INC
Entity type:Organization
Organization Name:SOUTH SUBURBAN HEARING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS, ACA
Authorized Official - Phone:708-966-4724
Mailing Address - Street 1:14316 S. WILL-COOK RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491
Mailing Address - Country:US
Mailing Address - Phone:708-966-4724
Mailing Address - Fax:708-949-8015
Practice Address - Street 1:14316 S. WILL-COOK RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491
Practice Address - Country:US
Practice Address - Phone:708-966-4724
Practice Address - Fax:708-949-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
IL2697237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty