Provider Demographics
NPI:1023228301
Name:JON WEAVER AUDIOLOGY AND HEARING AIDS, INC
Entity type:Organization
Organization Name:JON WEAVER AUDIOLOGY AND HEARING AIDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:765-457-4261
Mailing Address - Street 1:1542 S DIXON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-7318
Mailing Address - Country:US
Mailing Address - Phone:765-457-4261
Mailing Address - Fax:765-452-7655
Practice Address - Street 1:1542 S DIXON RD
Practice Address - Street 2:SUITE F
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-7318
Practice Address - Country:US
Practice Address - Phone:765-457-4261
Practice Address - Fax:765-452-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001956A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty