Organization
HEARING AID SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKIE RUSSELL (OWNER)
(574) 256-0000
Entity
Organization
Contact information
Practice address
3718 LINCOLNWAY E, MISHAWAKA, IN 46544
(574) 256-0000
Mailing address
3718 LINCOLNWAY E, MISHAWAKA, IN 46544-3922
(574) 256-0000
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
17001314A
IN
Other
Enumeration date
01/02/2015
Last updated
01/02/2015
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