Organization
SPOON RIVER HEARING SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDI GREENE DEFORD M.S. CCC-A (AUDIOLOGIST)
(309) 647-0201
Entity
Organization
Contact information
Practice address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 649-8950
Mailing address
811 W AVENUE H, LEWISTOWN, IL 61542-8363
(309) 647-0201
(309) 649-8950
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
147000582
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35672291302
—
IL
Enumeration date
04/12/2007
Last updated
08/07/2014
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