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Organization
TRI-COUNTY HEARING
Active
Organization
TRI-COUNTY HEARING
Active
Other names
Avada Audiology & Hearing Care
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN SULLIVAN (OFFICE MANAGER)
(708) 636-7500
Entity
Organization
Contact information
Practice address
4237 W 95TH ST, OAK LAWN, IL 60453-2623
(708) 636-7500
(708) 636-7652
Mailing address
140 CORPORATE DR., SUITE 1, BEAVER DAM, WI 53916
(920) 887-2822
(920) 887-9655
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2676
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001620840
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/10/2007
Last updated
08/22/2020
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