Organization
SELECTIVE HEARING CENTERS, LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY JAY JOHNSTON BC-HIS (PRESIDENT)
(262) 577-5577
Entity
Organization
Contact information
Practice address
6804 GREEN BAY RD STE 113, KENOSHA, WI 53142-1451
(262) 577-5577
(262) 577-5511
Mailing address
6804 GREEN BAY RD STE 113, KENOSHA, WI 53142-1451
(262) 577-5577
(262) 577-5511
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
1310-060
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1310-060
STATE LICENSE
WI
Enumeration date
04/03/2013
Last updated
02/12/2020
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