Provider Demographics
NPI:1871627182
Name:CHAMPAIGN HEARING AID SERVICE, INC
Entity type:Organization
Organization Name:CHAMPAIGN HEARING AID SERVICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-443-0682
Mailing Address - Street 1:710 N VERMILION STREET
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-443-0682
Mailing Address - Fax:217-443-8358
Practice Address - Street 1:710 N VERMILION STREET
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-443-0682
Practice Address - Fax:217-443-8358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0289237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty