Individual
MR. STEPHEN DALE GANNAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
3143 W JEFFERSON ST, JOLIET, IL 60435-4733
(815) 744-6898
(815) 744-2486
Mailing address
6 VICTORY DRIVE, LIBERTY, MO 64068
(816) 883-2660
(816) 792-9819
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
147000243
IL
Other
Enumeration date
09/04/2006
Last updated
03/26/2013
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